Healthcare Provider Details

I. General information

NPI: 1205122108
Provider Name (Legal Business Name): COMMUNITY MENTAL HEALTH COUNCIL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5660 S SANGAMON ST
CHICAGO IL
60621-2208
US

IV. Provider business mailing address

8704 S CONSTANCE AVE
CHICAGO IL
60617-2746
US

V. Phone/Fax

Practice location:
  • Phone: 773-734-4033
  • Fax: 773-734-6447
Mailing address:
  • Phone: 773-734-4033
  • Fax: 773-734-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number04033
License Number StateIL

VIII. Authorized Official

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