Provider Demographics
NPI:1891854253
Name:CONNIE VAISVILAS-TAYLOR & ASSOCIATES IN COUNSELING P.C.
Entity Type:Organization
Organization Name:CONNIE VAISVILAS-TAYLOR & ASSOCIATES IN COUNSELING P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VAISVILAS-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CEAP, SAP,CADC
Authorized Official - Phone:815-741-2300
Mailing Address - Street 1:3033 W JEFFERSON ST
Mailing Address - Street 2:SUITE 219
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5261
Mailing Address - Country:US
Mailing Address - Phone:815-741-2300
Mailing Address - Fax:815-741-8003
Practice Address - Street 1:3033 W JEFFERSON ST
Practice Address - Street 2:SUITE 219
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5261
Practice Address - Country:US
Practice Address - Phone:815-741-2300
Practice Address - Fax:815-741-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0009932372OtherPROVIDER NUMBER BCBS
IL339054OtherPROVIDER NUMBER VALUE OPT