Provider Demographics
NPI:1790401719
Name:THE RETREAT COUNSELING CENTER PLLC
Entity Type:Organization
Organization Name:THE RETREAT COUNSELING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:309-306-2680
Mailing Address - Street 1:1185 COUNTY ROAD 700 N
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:IL
Mailing Address - Zip Code:61530-9316
Mailing Address - Country:US
Mailing Address - Phone:309-306-2680
Mailing Address - Fax:
Practice Address - Street 1:3 LEGACY STE 1
Practice Address - Street 2:
Practice Address - City:GOODFIELD
Practice Address - State:IL
Practice Address - Zip Code:61742-9676
Practice Address - Country:US
Practice Address - Phone:309-306-2680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty