Healthcare Provider Details

I. General information

NPI: 1720852593
Provider Name (Legal Business Name): PREMIER TREATMENT & COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 VOLLMER RD
FLOSSMOOR IL
60422-2013
US

IV. Provider business mailing address

3235 VOLLMER RD
FLOSSMOOR IL
60422-2013
US

V. Phone/Fax

Practice location:
  • Phone: 708-914-2005
  • Fax: 708-914-2008
Mailing address:
  • Phone: 708-914-2005
  • Fax: 708-914-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MAUREEN HALL
Title or Position: OWNER
Credential: CADC
Phone: 708-914-2005