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General NPI Number Information
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NPI Number | 1952418469
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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 | 08/23/2006
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 2545 W NORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60647-5296
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Country | US
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Telephone | 773-769-0205
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Fax | 773-765-0801
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Provider Business Mailing Address
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Address Line | 2014 W BELLE PLAINE AVE
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City | CHICAGO
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State | IL
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Zip | 60618-3002
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Country | US
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Telephone | 872-235-0722
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Fax | 872-235-0730
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Authorized Official
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Title or Position | REVENUE CYCLE MANAGER
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Name | KELLY DAVIS
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Credential |
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Telephone | 872-235-0258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 04029
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License Number State | IL
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