Provider Demographics
NPI:1851691091
Name:POVOLNY COUNSELING AND PSYCHOLOGICAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:POVOLNY COUNSELING AND PSYCHOLOGICAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:POVOLNY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-415-0780
Mailing Address - Street 1:188 W INDUSTRIAL DR
Mailing Address - Street 2:SUITE 132
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1623
Mailing Address - Country:US
Mailing Address - Phone:630-415-0780
Mailing Address - Fax:
Practice Address - Street 1:188 W INDUSTRIAL DR
Practice Address - Street 2:SUITE 132
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-1623
Practice Address - Country:US
Practice Address - Phone:630-415-0780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005235103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty