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General NPI Number Information
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NPI Number | 1114006210
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Entity Type | Organization
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Legal Business Name | CHATHAM PRESBYTERIAN CHURCH
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 1835 E WALNUT ST
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City | CHATHAM
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State | IL
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Zip | 62629-1578
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Country | US
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Telephone | 217-483-1224
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Fax | 217-483-7135
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Provider Business Mailing Address
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Address Line | 1835 E WALNUT ST
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City | CHATHAM
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State | IL
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Zip | 62629-1578
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Country | US
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Telephone | 217-483-1224
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Fax | 217-483-7135
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. DONNA J THURSTON
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Credential | LCPC
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Telephone | 217-483-1224
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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 | 180003064
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License Number State | IL
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