Healthcare Provider Details

I. General information

NPI: 1497036610
Provider Name (Legal Business Name): SAFE HARBOR CHRISTIAN COUNSELING CHICAGO WEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 ORVILLE ROAD
NAPERVILLE IL
60564
US

IV. Provider business mailing address

1207 ORVILLE ROAD
NAPERVILLE IL
60564
US

V. Phone/Fax

Practice location:
  • Phone: 630-904-8548
  • Fax: 410-569-0094
Mailing address:
  • Phone: 630-904-8548
  • Fax: 410-569-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name: GARY SMITH
Title or Position: DIRECTOR
Credential: MA
Phone: 630-304-8548