Provider Demographics
NPI:1659962777
Name:NAPERVILLE COUNSELING CENTER
Entity Type:Organization
Organization Name:NAPERVILLE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPORTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, NCC, CADC
Authorized Official - Phone:630-590-9522
Mailing Address - Street 1:582 COLCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-5208
Mailing Address - Country:US
Mailing Address - Phone:708-601-1185
Mailing Address - Fax:
Practice Address - Street 1:2132 DEEP WATER LN STE 216
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8569
Practice Address - Country:US
Practice Address - Phone:630-590-9522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAPORTE COUNSELING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1124497045Medicaid
IL1235408618Medicaid