Provider Demographics
NPI:1871310789
Name:CONNECTED LIVING COUNSELING & THERAPEUTIC SERVICES, LLC
Entity type:Organization
Organization Name:CONNECTED LIVING COUNSELING & THERAPEUTIC SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOSHANAH
Authorized Official - Middle Name:
Authorized Official - Last Name:YEHUDAH
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-395-6083
Mailing Address - Street 1:18220 HARWOOD AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2151
Mailing Address - Country:US
Mailing Address - Phone:708-365-6501
Mailing Address - Fax:708-844-0978
Practice Address - Street 1:18220 HARWOOD AVE STE 5
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2151
Practice Address - Country:US
Practice Address - Phone:708-365-6501
Practice Address - Fax:708-844-0978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)