Healthcare Provider Details

I. General information

NPI: 1437683679
Provider Name (Legal Business Name): LUTHERAN CHILD AND FAMILY SERVICE OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2826 N. MONROE STREET
DECATUR IL
62526
US

IV. Provider business mailing address

ONE OAKBROOK TERRACE SUITE #501
OAKBROOK TERRACE IL
60181
US

V. Phone/Fax

Practice location:
  • Phone: 217-428-8380
  • Fax:
Mailing address:
  • Phone: 708-771-7180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number12998-11
License Number StateIL

VIII. Authorized Official

Name: JAMES ALLEN WEBSTER
Title or Position: SYSTEM SUPPORT ANALYST
Credential:
Phone: 708-907-1583