Healthcare Provider Details

I. General information

NPI: 1942737606
Provider Name (Legal Business Name): COUNTY OF KENDALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W JOHN ST
YORKVILLE IL
60560-9249
US

IV. Provider business mailing address

811 W JOHN ST
YORKVILLE IL
60560-9249
US

V. Phone/Fax

Practice location:
  • Phone: 630-553-9100
  • Fax: 630-553-0167
Mailing address:
  • Phone: 630-553-9100
  • Fax: 630-553-0167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number17007
License Number StateIL

VIII. Authorized Official

Name: DR. AMAAL TOKARS
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 630-553-9100