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NPI Code Detail

MEDICARE: COMMUNITY COUNSELING CENTERS OF CHICAGO

MEDICARE: COMMUNITY COUNSELING CENTERS OF CHICAGO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)04029IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11616824OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1083634901
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY COUNSELING CENTERS OF CHICAGO
Provider Business Mailing Address
First Line : 4740 N. CLARK ST.
Second Line :
City : CHICAGO
State : IL
Zip : 60640
Country : US
Telephone Number : 773-769-0205
Fax Number : 773-765-0801
Provider Business Practice Location Address
First Line : 4740 N CLARK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4689
Country : US
Telephone Number : 773-769-0205
Fax Number : 773-765-0801
Authorized Official
Title or Position : PRESIDENT & CHIEF EXECUTIVE OFFICER
Name : DR. ANTHONY A KOPERA
Credential : PHD
Telephone Number : 773-769-0205
Provider Enumeration Date : 07/21/2006
Last Update Date : 04/20/2008

Similar Medicare Providers

1861411357 — TODD FREDERICK HARRISON LCSW
Practice Location Address:
4740 N CLARK ST , C/O C4
CHICAGO, IL
60640-4689
Practice Phone: 773-769-0205
Practice Fax:
1982626933 — MS. SARA ANN LINDSTROM LCSW
Practice Location Address:
4740 N CLARK ST
CHICAGO, IL
60640-4689
Practice Phone: 773-769-0205
Practice Fax:
1356363394 — MELANIE C. GEYER LCSW
Practice Location Address:
4740 N CLARK ST
CHICAGO, IL
60640-4689
Practice Phone: 773-769-0205
Practice Fax:
1760405724 — MS. JILL WESTERFELHAUS LCPC
Practice Location Address:
4740 N CLARK ST
CHICAGO, IL
60640-4689
Practice Phone: 773-765-0735
Practice Fax: 773-765-0730
1265455653 — VIVIANA PLOPER MA
Practice Location Address:
4740 N CLARK ST
CHICAGO, IL
60640-4689
Practice Phone: 773-765-0820
Practice Fax: 773-765-0839
1467476846 — MR. BRUCE FORBES SEITZER M.A.
Practice Location Address:
4740 N CLARK ST
CHICAGO, IL
60640-4689
Practice Phone: 773-765-0790
Practice Fax:

Directions to “COMMUNITY COUNSELING CENTERS OF CHICAGO ” Practice Location

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