Provider Demographics
NPI:1952852485
Name:THE SELF-CARE PATH, LLC
Entity Type:Organization
Organization Name:THE SELF-CARE PATH, LLC
Other - Org Name:FIREFIGHTER BEHAVIORAL HEALTH OF ILLINOIS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GURA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:815-557-1267
Mailing Address - Street 1:1333 BURR RIDGE PKWY
Mailing Address - Street 2:200
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6423
Mailing Address - Country:US
Mailing Address - Phone:708-429-0353
Mailing Address - Fax:386-263-8326
Practice Address - Street 1:1333 BURR RIDGE PKWY
Practice Address - Street 2:200
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-6423
Practice Address - Country:US
Practice Address - Phone:708-429-0353
Practice Address - Fax:386-263-8326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007613101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty