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General NPI Number Information
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NPI Number | 1023442753
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Entity Type | Organization
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Legal Business Name | PLCCA
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 411 MADISON W ST
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City | MAYWOOD
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State | IL
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Zip | 60153-2136
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Country | US
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Telephone | 708-450-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 411 MADISON W ST
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City | MAYWOOD
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State | IL
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Zip | 60153-2136
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DATA/BILLING SPECIALIST
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Name | MS. PAMELA M YATES
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Credential |
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Telephone | 708-450-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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