Provider Demographics
NPI:1619493855
Name:BRICOLAGE WELLNESS, LLC
Entity Type:Organization
Organization Name:BRICOLAGE WELLNESS, LLC
Other - Org Name:CLARITY COUNSELING AND WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEPRICH-GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-866-5666
Mailing Address - Street 1:477 E BUTTERFIELD RD STE 212
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4879
Mailing Address - Country:US
Mailing Address - Phone:630-866-5666
Mailing Address - Fax:
Practice Address - Street 1:477 E BUTTERFIELD RD STE 212
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4879
Practice Address - Country:US
Practice Address - Phone:630-866-5666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010822101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149014623OtherIDPFR
IL180010822OtherIDPFR
IL149015800OtherIDPFR
IL178013661OtherIDPFR