Basic Information
| Provider Information | |||||||||
| NPI: | 1205489036 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SERENITY COUNSEILNG SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25260 W BUELL ST | ||||||||
| Address2: | |||||||||
| City: | CHANNAHON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604105535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8158232876 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1002 N 129TH INFANTRY DR STE F | ||||||||
| Address2: | |||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604353109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8158232876 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2019 | ||||||||
| LastUpdateDate: | 07/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | GARLAND | ||||||||
| AuthorizedOfficialFirstName: | MEGHAN | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8158232876 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SERENITY COUNSELLING SERVICES | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1003146572 | 01 | IL | THERAPY | OTHER |