Provider Demographics
NPI:1942086111
Name:CONGRUENCY INTEGRATED COUNSELING, PLLC
Entity Type:Organization
Organization Name:CONGRUENCY INTEGRATED COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:EWELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-986-5385
Mailing Address - Street 1:106 W CALENDAR AVE STE 80
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2325
Mailing Address - Country:US
Mailing Address - Phone:847-986-5385
Mailing Address - Fax:
Practice Address - Street 1:2313 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1260
Practice Address - Country:US
Practice Address - Phone:847-986-5385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty