Healthcare Provider Details

I. General information

NPI: 1558531947
Provider Name (Legal Business Name): THE LARKIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 SUMMIT ST
ELGIN IL
60120-3829
US

IV. Provider business mailing address

1212 LARKIN AVE
ELGIN IL
60123-6042
US

V. Phone/Fax

Practice location:
  • Phone: 847-608-2682
  • Fax:
Mailing address:
  • Phone: 847-695-5656
  • Fax: 847-695-0897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number38443402033068
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number38443402033068
License Number StateIL

VIII. Authorized Official

Name: MR. DENNIS L GRAF
Title or Position: EXECUTIVE DIRECTOR
Credential: M.A.
Phone: 847-695-5656