Organization
WESTERN LAKE
Active
Other names
COUNSELING & DUI PROGRAMS LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFF ROY HEDIEN MA NCC CADC (DIRECTOR/ SOLE MBR OWNER)
(847) 587-9700
Entity
Organization
Contact information
Practice address
21 W GRAND AVE, FOX LAKE, IL 60020-1209
(847) 587-9700
(847) 587-8584
Mailing address
21 W GRAND AVE, FOX LAKE, IL 60020-1209
(847) 587-9700
(847) 587-8584
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
A-1450-0002-A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A 1450 0002 A
DEPT OF HUMAN SERVICES OFFICE OF ALCOHOL & SUBSTANCE ABUSE (DHS/DASA)
—
Enumeration date
10/11/2006
Last updated
07/16/2008
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