Healthcare Provider Details

I. General information

NPI: 1598820300
Provider Name (Legal Business Name): FAMILY SERVICE AGENCY OF DEKALB COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SYCAMORE RD
DEKALB IL
60115-2483
US

IV. Provider business mailing address

1325 SYCAMORE RD
DEKALB IL
60115-2483
US

V. Phone/Fax

Practice location:
  • Phone: 815-758-8616
  • Fax: 815-758-7569
Mailing address:
  • Phone: 815-758-8616
  • Fax: 815-758-7569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TYNISHA L CLEGG
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 815-758-8616