Provider Demographics
NPI:1841899671
Name:LIVING WATERS COUNSELING AND CONSULTING SERVICES NFP
Entity type:Organization
Organization Name:LIVING WATERS COUNSELING AND CONSULTING SERVICES NFP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC
Authorized Official - Phone:708-271-5370
Mailing Address - Street 1:8157 S ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-3857
Mailing Address - Country:US
Mailing Address - Phone:708-271-5370
Mailing Address - Fax:773-873-5333
Practice Address - Street 1:4550 W 103RD ST STE 302B
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4868
Practice Address - Country:US
Practice Address - Phone:773-280-5675
Practice Address - Fax:773-873-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL326549937001Medicaid