Healthcare Provider Details

I. General information

NPI: 1225743933
Provider Name (Legal Business Name): ALLEN'S FAMILY COUNSELING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16700 SOUTH HALSTED ST
HARVEY IL
60426-6065
US

IV. Provider business mailing address

226 W ONTARIO ST STE 400C
CHICAGO IL
60654-3619
US

V. Phone/Fax

Practice location:
  • Phone: 312-912-7008
  • Fax: 312-533-2842
Mailing address:
  • Phone: 312-912-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DOUGLAS L ALLEN
Title or Position: CEO
Credential: MS,QMHP, CADC, CODP1
Phone: 708-728-5470