Healthcare Provider Details

I. General information

NPI: 1790981934
Provider Name (Legal Business Name): FAMILY COUNSELING INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E 162ND ST SUITE 211
SOUTH HOLLAND IL
60473-2471
US

IV. Provider business mailing address

900 E 162ND ST SUITE 211
SOUTH HOLLAND IL
60473-2471
US

V. Phone/Fax

Practice location:
  • Phone: 708-225-1237
  • Fax: 708-225-1338
Mailing address:
  • Phone: 708-225-1237
  • Fax: 708-225-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180001558
License Number StateIL

VIII. Authorized Official

Name: MR. NATHANIEL L. GILHAM
Title or Position: MANAGING PARTNER
Credential: LCPC
Phone: 708-225-1237