Provider Demographics
NPI:1700524089
Name:AT THE WELL COUNSELING, INC
Entity type:Organization
Organization Name:AT THE WELL COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-772-8643
Mailing Address - Street 1:353 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-3044
Mailing Address - Country:US
Mailing Address - Phone:847-772-8643
Mailing Address - Fax:
Practice Address - Street 1:1000 HART RD STE 130
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2668
Practice Address - Country:US
Practice Address - Phone:847-772-8643
Practice Address - Fax:224-848-4561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health