Organization
MENTAL EDGE COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN LAGACY (OWNER)
(815) 953-2553
Entity
Organization
Contact information
Practice address
11106 FRONT ST, MOKENA, IL 60448-1587
(815) 953-2553
Mailing address
11106 FRONT ST, MOKENA, IL 60448-1587
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
180010099
IL
Other
Enumeration date
04/24/2016
Last updated
04/24/2016
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