Provider Demographics
NPI:1205664042
Name:VILLANUEVA KHAN CONSELING PLLC
Entity type:Organization
Organization Name:VILLANUEVA KHAN CONSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:M ROSARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLANUEVA-KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, ICDVP, CADC
Authorized Official - Phone:708-351-4686
Mailing Address - Street 1:11311 BROOK CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-4474
Mailing Address - Country:US
Mailing Address - Phone:708-351-4686
Mailing Address - Fax:
Practice Address - Street 1:310 N HAMMES AVE STE 201C
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8118
Practice Address - Country:US
Practice Address - Phone:815-806-7222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty