Provider Demographics
NPI:1013532191
Name:COGNITIVE CARE COUNSELING, PLLC
Entity Type:Organization
Organization Name:COGNITIVE CARE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CLINICAL OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-347-8258
Mailing Address - Street 1:11369 TIMER DR
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-6935
Mailing Address - Country:US
Mailing Address - Phone:815-347-8258
Mailing Address - Fax:
Practice Address - Street 1:11369 TIMER DR
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-6935
Practice Address - Country:US
Practice Address - Phone:815-347-8258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-14
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty