Provider Demographics
NPI:1184428922
Name:AMARYLLIS COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:AMARYLLIS COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:224-856-8829
Mailing Address - Street 1:606 CARRIAGE HILL CT
Mailing Address - Street 2:
Mailing Address - City:ISLAND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60042-9597
Mailing Address - Country:US
Mailing Address - Phone:224-856-8829
Mailing Address - Fax:
Practice Address - Street 1:800 S MILWAUKEE AVE STE 105
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3268
Practice Address - Country:US
Practice Address - Phone:224-856-8829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty