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NPI Code Detail

MEDICARE: COUNSELING CENTER OF ILLINOIS, INC.

MEDICARE: COUNSELING CENTER OF ILLINOIS, INC.
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1679913065
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNSELING CENTER OF ILLINOIS, INC.
Provider Business Mailing Address
First Line : 4515 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-3711
Country : US
Telephone Number : 773-777-6767
Fax Number : 773-777-7274
Provider Business Practice Location Address
First Line : 4515 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-3711
Country : US
Telephone Number : 773-777-6767
Fax Number : 773-777-7274
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : ANNA JANKOWSKA
Credential : MA LCPC CEAP SAP
Telephone Number : 773-777-6767
Provider Enumeration Date : 06/28/2013
Last Update Date : 06/28/2013

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