| Untangle Counseling Pllc | |
|
152 Elgin Ave Apt 3 Forest Park IL 60130-1300 | |
| (224) 639-7776 | |
| Not Available |
| Full Name | Untangle Counseling Pllc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 152 Elgin Ave Apt 3, Forest Park, Illinois |
| Authorized Official Name and Position | Samantha K Agins (MANAGER) |
| Authorized Official Contact | 2246397776 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Untangle Counseling Pllc 417 Des Plaines Ave Unit 641 Forest Park IL 60130-4433 Ph: (224) 639-7776 | Untangle Counseling Pllc 152 Elgin Ave Apt 3 Forest Park IL 60130-1300 Ph: (224) 639-7776 |
| NPI Number | 1780276154 |
|---|---|
| Provider Enumeration Date | 02/08/2021 |
| Last Update Date | 02/08/2021 |
| Certification Date | 02/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780276154 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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