MEDICARE: A & K CHILD GUIDANCE CENTER, 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
1	251S00000X	Community/Behavioral Health Agency	036.119188	IL

General Provider Information

NPI Number	:	1841438975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A & K CHILD GUIDANCE CENTER, INC.

Provider Business Mailing Address
First Line	:	200 E EVERGREEN AVE STE 123
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-3294
Country	:	US
Telephone Number	:	630-337-2893
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 E EVERGREEN AVE STE 123
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-3294
Country	:	US
Telephone Number	:	630-337-2897
Fax Number	:

Authorized Official
Title or Position	:	SHARE HOLDER
Name	:	DR. MOHAMMED ALI
Credential	:	MD
Telephone Number	:	630-337-2893

Provider Enumeration Date	:	01/28/2009
Last Update Date	:	01/28/2009

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