Provider Demographics
NPI:1477389716
Name:SOPHRON COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:SOPHRON COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCKENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-408-1262
Mailing Address - Street 1:187 S INDIANA AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3645
Mailing Address - Country:US
Mailing Address - Phone:815-408-1262
Mailing Address - Fax:815-401-7684
Practice Address - Street 1:187 S INDIANA AVE STE 307
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3645
Practice Address - Country:US
Practice Address - Phone:815-408-1262
Practice Address - Fax:815-401-7684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder