Healthcare Provider Details

I. General information

NPI: 1659743631
Provider Name (Legal Business Name): DREXEL COUNSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 E 93RD ST
CHICAGO IL
60619-7814
US

IV. Provider business mailing address

936 E 93RD ST
CHICAGO IL
60619-7814
US

V. Phone/Fax

Practice location:
  • Phone: 773-731-5395
  • Fax: 773-336-5545
Mailing address:
  • Phone: 773-731-5395
  • Fax: 773-336-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: KATHY HARDIN EARL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-731-5395