Organization
BROADREACH COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE HENOCH LCPC (CO-OWNER/PSYCHOTHERAPIST)
(847) 348-9501
Entity
Organization
Contact information
Practice address
1580 S MILWAUKEE AVE STE 104, LIBERTYVILLE, IL 60048-3770
(847) 636-6134
Mailing address
1580 S MILWAUKEE AVE STE 104, LIBERTYVILLE, IL 60048-3770
(847) 348-9501
(847) 264-9247
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
180.010359
IL
1041C0700X
Clinical Social Worker
Primary
149.018710
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
331742678001
—
IL
Enumeration date
08/08/2017
Last updated
11/13/2017
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