Provider Demographics
NPI:1366985145
Name:TAKING CONTROL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:TAKING CONTROL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGENSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD; LCPC
Authorized Official - Phone:630-801-1669
Mailing Address - Street 1:106F S LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-1597
Mailing Address - Country:US
Mailing Address - Phone:630-801-1669
Mailing Address - Fax:
Practice Address - Street 1:106F S LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1597
Practice Address - Country:US
Practice Address - Phone:630-801-1669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2021-12-22
Deactivation Date:2021-11-30
Deactivation Code:
Reactivation Date:2021-12-22
Provider Licenses
StateLicense IDTaxonomies
251S00000X
IL180.003228261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid