Provider Demographics
NPI:1639525306
Name:NORTHERN LIGHTS GUIDANCE AND COUNSELING LLC
Entity type:Organization
Organization Name:NORTHERN LIGHTS GUIDANCE AND COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST CLINICAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:847-987-6421
Mailing Address - Street 1:406 W HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-2606
Mailing Address - Country:US
Mailing Address - Phone:847-987-6421
Mailing Address - Fax:
Practice Address - Street 1:406 W HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-2606
Practice Address - Country:US
Practice Address - Phone:847-987-6421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty