Provider Demographics
NPI:1689333726
Name:TAKE HEART COUNSELING
Entity Type:Organization
Organization Name:TAKE HEART COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:EISIN-BANAZEK
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-967-9085
Mailing Address - Street 1:1309 W COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4325
Mailing Address - Country:US
Mailing Address - Phone:773-720-2911
Mailing Address - Fax:
Practice Address - Street 1:1309 W COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-4325
Practice Address - Country:US
Practice Address - Phone:773-967-9085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty