Provider Demographics
NPI:1043510621
Name:NORTHWESTERN LAKE COUNSELING
Entity type:Organization
Organization Name:NORTHWESTERN LAKE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:LETA
Authorized Official - Last Name:KRIEGER
Authorized Official - Suffix:
Authorized Official - Credentials:RNCADCCRSS
Authorized Official - Phone:847-587-8400
Mailing Address - Street 1:17 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:FOX LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60020-1209
Mailing Address - Country:US
Mailing Address - Phone:847-587-8400
Mailing Address - Fax:847-587-8407
Practice Address - Street 1:17 WEST GRAND AVE.
Practice Address - Street 2:
Practice Address - City:FOX LAKE
Practice Address - State:IL
Practice Address - Zip Code:60020
Practice Address - Country:US
Practice Address - Phone:847-587-8400
Practice Address - Fax:847-587-8407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-2237-0001-A252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1720398092OtherCADC
IL1356679534OtherRNCADCCRSS
IL1598075269OtherCADC