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General NPI Number Information
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NPI Number | 1881923910
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Entity Type | Organization
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Legal Business Name | JOIL CENTER
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Dates
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Enumeration Date | 12/20/2009
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Last Update Date | 12/20/2009
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Provider Practice Location Address
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Address Line | 5140 W MELROSE ST
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City | CHICAGO
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State | IL
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Zip | 60641-4224
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Country | US
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Telephone | 773-653-3059
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Fax | 773-526-7512
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Provider Business Mailing Address
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Address Line | 5140 W MELROSE ST
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City | CHICAGO
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State | IL
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Zip | 60641-4224
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Country | US
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Telephone | 773-653-3059
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Fax | 773-526-7512
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. LANA YAEL PECK
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Credential | LCPC
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Telephone | 773-653-3059
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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 | 178004814
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License Number State | IL
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