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General NPI Number Information
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NPI Number | 1699372250
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Entity Type | Organization
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Legal Business Name | CTF ILLINOIS
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 1400 REYNOLDS DR
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City | CHARLESTON
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State | IL
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Zip | 61920-2411
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Country | US
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Telephone | 708-429-1260
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Fax |
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Provider Business Mailing Address
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Address Line | 18230 ORLAND PKWY
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City | ORLAND PARK
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State | IL
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Zip | 60467-5688
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Country | US
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Telephone | 708-294-1260
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE ASSISTANT
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Name | KELLI L CODY
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Credential |
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Telephone | 708-429-1260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 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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