Provider Demographics
NPI:1952038127
Name:COURAGEOUS SPACES COUNSELING & CONSULTING PLLC
Entity Type:Organization
Organization Name:COURAGEOUS SPACES COUNSELING & CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:HORBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-207-7624
Mailing Address - Street 1:15212 NAUGHTON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1115
Mailing Address - Country:US
Mailing Address - Phone:708-207-7624
Mailing Address - Fax:
Practice Address - Street 1:5233 HOHMAN AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-1742
Practice Address - Country:US
Practice Address - Phone:219-803-6561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-06
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty