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General NPI Number Information
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NPI Number | 1962807354
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Entity Type | Organization
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Legal Business Name | SENTER SOCIAL SERVICES LLC
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Dates
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Enumeration Date | 10/28/2014
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 3612 LINCOLN HWY SUITE # 4
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1627
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Country | US
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Telephone | 708-203-9445
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Fax |
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Provider Business Mailing Address
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Address Line | 3612 WEST LINCOLN HIGHWAY SUITE # 4
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461
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Country | US
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Telephone | 708-203-9445
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MRS. CONNIE JEAN SENTER
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Credential | LCSW
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Telephone | 708-203-9445
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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 | 149002957
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License Number State | IL
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