Provider Demographics
NPI:1295922557
Name:COUNSELING ASSOCIATES
Entity type:Organization
Organization Name:COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARYN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:INGRUM
Authorized Official - Suffix:I
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-479-4007
Mailing Address - Street 1:19015 S JODI RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8514
Mailing Address - Country:US
Mailing Address - Phone:708-479-4007
Mailing Address - Fax:708-479-4073
Practice Address - Street 1:19015 S JODI RD
Practice Address - Street 2:SUITE H
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8514
Practice Address - Country:US
Practice Address - Phone:708-479-4007
Practice Address - Fax:708-479-4073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health