Provider Demographics
NPI:1508681552
Name:TWIN IMAGE COUNSELING SERVICE PLLC
Entity type:Organization
Organization Name:TWIN IMAGE COUNSELING SERVICE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAMONT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIL
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-990-1103
Mailing Address - Street 1:414 1/2 N VAN BUREN AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-3233
Mailing Address - Country:US
Mailing Address - Phone:815-990-1103
Mailing Address - Fax:
Practice Address - Street 1:524 W STEPHENSON ST STE 205
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-5057
Practice Address - Country:US
Practice Address - Phone:815-990-1103
Practice Address - Fax:815-990-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty