Provider Demographics
NPI:1710250246
Name:MJK PURPOSEFUL COUNSELING, LLC
Entity Type:Organization
Organization Name:MJK PURPOSEFUL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KANT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-217-3597
Mailing Address - Street 1:5225 OLD ORCHARD ROAD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077
Mailing Address - Country:US
Mailing Address - Phone:312-217-3597
Mailing Address - Fax:
Practice Address - Street 1:5225 OLD ORCHARD ROAD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:312-217-3597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MJK PURPOSEFUL COUNSELING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490116391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty