Provider Demographics
NPI:1043971385
Name:CUP OF TEA COUNSELING, LLC
Entity type:Organization
Organization Name:CUP OF TEA COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:217-369-0819
Mailing Address - Street 1:101 GENTIAN
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-8544
Mailing Address - Country:US
Mailing Address - Phone:217-369-0819
Mailing Address - Fax:
Practice Address - Street 1:101 GENTIAN
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-8544
Practice Address - Country:US
Practice Address - Phone:217-369-0819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-09
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health