Healthcare Provider Details

I. General information

NPI: 1487950184
Provider Name (Legal Business Name): MONUMENT OUTREACH COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 W COLUMBUS AVE
CHICAGO IL
60652-1727
US

IV. Provider business mailing address

2750 W COLUMBUS AVE
CHICAGO IL
60652-1727
US

V. Phone/Fax

Practice location:
  • Phone: 312-735-2134
  • Fax: 773-918-1630
Mailing address:
  • Phone: 312-735-2134
  • Fax: 773-918-1630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOHN STEVEN HENTON
Title or Position: OWNER
Credential: D. D. PHD PC
Phone: 312-735-2134