MEDICARE: COMMUNITY MENTAL HEALTH COUNCIL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	04033	IL

General Provider Information

NPI Number	:	1205122108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY MENTAL HEALTH COUNCIL, INC.

Provider Business Mailing Address
First Line	:	8704 S CONSTANCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-2746
Country	:	US
Telephone Number	:	773-734-4033
Fax Number	:	773-734-6447

Provider Business Practice Location Address
First Line	:	5660 S SANGAMON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-2208
Country	:	US
Telephone Number	:	773-734-4033
Fax Number	:	773-734-6447

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	DR. CARL COMPTON BELL
Credential	:	M.D.
Telephone Number	:	773-734-4033

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	06/20/2011

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