Healthcare Provider Details

I. General information

NPI: 1376030643
Provider Name (Legal Business Name): FAMILY FIRST DOMESTIC & FAMILY COUNSELING CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2018
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9522 S HALSTED ST
CHICAGO IL
60628-1028
US

IV. Provider business mailing address

9522 S HALSTED ST
CHICAGO IL
60628-1028
US

V. Phone/Fax

Practice location:
  • Phone: 773-595-5794
  • Fax:
Mailing address:
  • Phone: 773-595-5794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY BROWN
Title or Position: OWNER
Credential:
Phone: 773-595-5794