Organization
COUNSELING CENTER OF GRAYSLAKE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE PETTINATO LCSW (OWNER)
(847) 962-9549
Entity
Organization
Contact information
Practice address
142 HAWLEY ST STE 5, GRAYSLAKE, IL 60030-3653
(847) 962-9549
Mailing address
34068 N WHITE OAK LN, GURNEE, IL 60031-4446
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
149.014706
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F300232686
MEDICARE PTAN
IL
Enumeration date
06/19/2016
Last updated
06/19/2016
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