Provider Demographics
NPI:1679089569
Name:ENVISION COUNSELING PLLC
Entity Type:Organization
Organization Name:ENVISION COUNSELING PLLC
Other - Org Name:GRACIE BATES-DAVIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST AND OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BATES-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-209-1984
Mailing Address - Street 1:53 W JACKSON BLVD STE 1439
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-3539
Mailing Address - Country:US
Mailing Address - Phone:773-209-1984
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 1439
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3539
Practice Address - Country:US
Practice Address - Phone:773-209-1984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009958101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty