Healthcare Provider Details

I. General information

NPI: 1063401206
Provider Name (Legal Business Name): CENTRAL DUPAGE PASTORAL COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 THORNHILL DR SUITE A
CAROL STREAM IL
60188-2706
US

IV. Provider business mailing address

507 THORNHILL DR SUITE A
CAROL STREAM IL
60188-2706
US

V. Phone/Fax

Practice location:
  • Phone: 630-752-9750
  • Fax: 630-752-9768
Mailing address:
  • Phone: 630-752-9750
  • Fax: 630-752-9768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number178002569
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071004746
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178001992
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180005369
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180002208
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071006345
License Number StateIL
# 9
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071006372
License Number StateIL
# 10
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. NANCY COCHRAN
Title or Position: EXECUTIVE DIRECTOR
Credential: PSYD
Phone: 630-752-9750