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General NPI Number Information
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NPI Number | 1427322791
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Entity Type | Organization
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Legal Business Name | CANTY-GRAY COUNSELING CENTER, LTD
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Dates
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Enumeration Date | 03/02/2012
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Last Update Date | 03/02/2012
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Provider Practice Location Address
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Address Line | 2601 LINCOLN HWY STE 111
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1866
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Country | US
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Telephone | 708-283-8000
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Fax | 708-283-8008
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Provider Business Mailing Address
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Address Line | 2601 LINCOLN HWY STE 111
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1866
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Country | US
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Telephone | 708-283-8000
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Fax | 708-283-8008
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. BUNIFAYE CANTY-GRAY
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Credential | L.C.P.C
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Telephone | 708-283-8000
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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 | 180006220
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License Number State | IL
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