Basic Information
| Provider Information | |||||||||
| NPI: | 1457846719 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PLEASANT COUNSELING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 335 E WOOD ST STE B | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625231431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174226908 | ||||||||
| FaxNumber: | 2174227103 | ||||||||
| Practice Location | |||||||||
| Address1: | 335 E WOOD ST STE B | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625231431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174226908 | ||||||||
| FaxNumber: | 2174227103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2018 | ||||||||
| LastUpdateDate: | 06/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | PLEASANT | ||||||||
| AuthorizedOfficialFirstName: | DIANE | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2174226908 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSYD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | A-5441-0003-A | IL | N | Agencies | Case Management | 261Q00000X | A-5441-0003-A | IL | N | Ambulatory Health Care Facilities | Clinic/Center | 261QM0801X | 180-005694 | IL | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0850X | 180-005694 | IL | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | 180-005694 | IL | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 251S00000X | A-5441-0003-A | IL | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 202415440001 | 05 | IL | MEDICAID |