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	101YP2500X	Professional Counselor		IL

General Provider Information

NPI Number	:	1255492443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY MENTAL HEALTH COUNCIL INC.

Provider Business Mailing Address
First Line	:	7330 S MERRILL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-3209
Country	:	US
Telephone Number	:	773-447-2589
Fax Number	:

Provider Business Practice Location 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	:	773-731-9695

Authorized Official
Title or Position	:	DIRECTOR, MANAGED CARE
Name	:	MRS. CAROL ANN TAYLOR I
Credential	:	M.A.
Telephone Number	:	773-734-4033

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	08/22/2020

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