=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962616904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCESS COUNSELING CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2007
-----------------------------------------------------
Last Update Date | 06/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 W. 177TH STREET SUITE 3F
-----------------------------------------------------
City | HAZEL CREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 798-408-9125
-----------------------------------------------------
Fax | 708-799-1889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18303 ROBIN LN
-----------------------------------------------------
City | HOMEWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60430-2856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-419-8288
-----------------------------------------------------
Fax | 708-799-1889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT CEO
-----------------------------------------------------
Name | ROBERT EMIL THURMAN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 773-419-8288
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149-007753
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------