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General NPI Number Information
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NPI Number | 1376841262
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Entity Type | Organization
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Legal Business Name | COMMUNITY COUNSELING CENTERS OF CHICAGO
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 2525 W PETERSON AVE
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City | CHICAGO
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State | IL
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Zip | 60659-4108
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Country | US
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Telephone | 773-506-0707
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 W PETERSON AVE
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City | CHICAGO
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State | IL
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Zip | 60659-4108
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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 | CEO
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Name | DR. ANTHONY A KOPERA
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Credential |
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Telephone | 773-769-0205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 149014521
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License Number State | IL
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