Provider Demographics
NPI:1952199374
Name:DEFINING MOMENTS LLC
Entity type:Organization
Organization Name:DEFINING MOMENTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WOLTER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LCPC
Authorized Official - Phone:815-909-6586
Mailing Address - Street 1:2155 CARPENTER AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-5943
Mailing Address - Country:US
Mailing Address - Phone:816-909-6586
Mailing Address - Fax:
Practice Address - Street 1:2155 CARPENTER AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-5943
Practice Address - Country:US
Practice Address - Phone:816-909-6586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-26
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health