Provider Demographics
NPI:1700895877
Name:SOJOURNER CENTER FOR COUNSELING, INC.
Entity Type:Organization
Organization Name:SOJOURNER CENTER FOR COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:TIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA LCPC
Authorized Official - Phone:847-566-3136
Mailing Address - Street 1:10 EXECUTIVE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-7509
Mailing Address - Country:US
Mailing Address - Phone:847-566-3136
Mailing Address - Fax:
Practice Address - Street 1:10 EXECUTIVE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:HAWTHORN WOODS
Practice Address - State:IL
Practice Address - Zip Code:60047-7509
Practice Address - Country:US
Practice Address - Phone:847-566-3136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0007854629OtherAETNA
IL04932018OtherBLUE CROSS & BLUE SHIELD