Healthcare Provider Details

I. General information

NPI: 1659151496
Provider Name (Legal Business Name): JOURNEY'S COMMUNITY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6632 ROOSEVELT RD
OAK PARK IL
60304-2059
US

IV. Provider business mailing address

4939 W FULLERTON AVE
CHICAGO IL
60639-2505
US

V. Phone/Fax

Practice location:
  • Phone: 708-683-9725
  • Fax:
Mailing address:
  • Phone: 708-683-9725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KATE M HARBERT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 708-683-9725