Provider Demographics
NPI:1205567260
Name:WOUNDED HEALERS COUNSELING SERVICE LLC
Entity type:Organization
Organization Name:WOUNDED HEALERS COUNSELING SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:331-300-5317
Mailing Address - Street 1:2404 MONTEREY DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-8475
Mailing Address - Country:US
Mailing Address - Phone:630-723-1006
Mailing Address - Fax:
Practice Address - Street 1:15724 S ROUTE 59 STE 106
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2806
Practice Address - Country:US
Practice Address - Phone:630-557-6057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL345923924001Medicaid