Provider Demographics
NPI:1861924474
Name:ONE TEN COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:ONE TEN COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-878-3715
Mailing Address - Street 1:110 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-1725
Mailing Address - Country:US
Mailing Address - Phone:815-878-3715
Mailing Address - Fax:
Practice Address - Street 1:110 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-1725
Practice Address - Country:US
Practice Address - Phone:815-878-3715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-02
Last Update Date:2017-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009986101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty