Provider Demographics
NPI:1790447332
Name:WITHU COUNSELING GROUP LLC
Entity Type:Organization
Organization Name:WITHU COUNSELING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:414-630-0375
Mailing Address - Street 1:7210 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2622
Mailing Address - Country:US
Mailing Address - Phone:815-839-2064
Mailing Address - Fax:815-839-2114
Practice Address - Street 1:7210 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2622
Practice Address - Country:US
Practice Address - Phone:815-839-2064
Practice Address - Fax:815-839-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty