Provider Demographics
NPI:1245042837
Name:CONNECT & GROW COUNSELING LLC
Entity type:Organization
Organization Name:CONNECT & GROW COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAN PEDRO-KOONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:773-971-1266
Mailing Address - Street 1:1350 BALD EAGLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-7415
Mailing Address - Country:US
Mailing Address - Phone:773-971-1266
Mailing Address - Fax:
Practice Address - Street 1:1350 BALD EAGLE DRIVE
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-7415
Practice Address - Country:US
Practice Address - Phone:773-971-1266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180012733OtherLICENSED CLINICAL PROFESSIONAL COUNSELOR LICENSE NUMBER
IL1982045175OtherINDIVIDUAL NPI NUMBER/TYPE 1 NPI
IL12583405OtherCAQH/PROVIEW NUMBER