Provider Demographics
NPI:1922267475
Name:SOUL CHOICE COUNSELING, LTD
Entity Type:Organization
Organization Name:SOUL CHOICE COUNSELING, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-328-8477
Mailing Address - Street 1:831 FOREST AVE
Mailing Address - Street 2:#3W
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2486
Mailing Address - Country:US
Mailing Address - Phone:847-328-8477
Mailing Address - Fax:
Practice Address - Street 1:831 FOREST AVE APT 3W
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2421
Practice Address - Country:US
Practice Address - Phone:773-332-5471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490067011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2251OtherMEDICARE PTAN FOR CORPORATION
ILIL2251001OtherMEDICARE PTAN FOR INDIVIDUAL