Provider Demographics
NPI:1770117293
Name:LB COUNSELING AND CONSULTING, LLC
Entity type:Organization
Organization Name:LB COUNSELING AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGSTEDT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-552-0226
Mailing Address - Street 1:310 N CONVENT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2175
Mailing Address - Country:US
Mailing Address - Phone:815-552-0226
Mailing Address - Fax:815-205-5376
Practice Address - Street 1:310 N CONVENT ST STE 2
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2175
Practice Address - Country:US
Practice Address - Phone:815-552-0226
Practice Address - Fax:815-205-5376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health