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General NPI Number Information
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NPI Number | 1609108539
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Entity Type | Organization
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Legal Business Name | DEER REHABILITATION SERVICES INC
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 3936 W ROOSEVELT RD
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City | CHICAGO
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State | IL
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Zip | 60624-4389
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Country | US
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Telephone | 773-826-0398
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Fax | 773-826-2327
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Provider Business Mailing Address
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Address Line | 3936 W ROOSEVELT RD
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City | CHICAGO
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State | IL
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Zip | 60624-4389
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Country | US
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Telephone | 773-826-0398
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Fax | 773-826-2327
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENNIS DEER
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Credential | DOCTOR OF COUNSELING
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Telephone | 773-826-0398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | A51920001A
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180003346
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License Number State | IL
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