Provider Demographics
NPI:1134715238
Name:INTENTIONAL FULFILLMENT COUNSELING L.L.C.
Entity type:Organization
Organization Name:INTENTIONAL FULFILLMENT COUNSELING L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:779-242-9571
Mailing Address - Street 1:429 N WEBER RD # 405
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-3902
Mailing Address - Country:US
Mailing Address - Phone:779-242-9571
Mailing Address - Fax:
Practice Address - Street 1:429 N WEBER RD # 405
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-3902
Practice Address - Country:US
Practice Address - Phone:779-242-9571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty