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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	04029	IL

General Provider Information

NPI Number	:	1952418469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY COUNSELING CENTERS OF CHICAGO

Provider Business Mailing Address
First Line	:	2014 W BELLE PLAINE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3002
Country	:	US
Telephone Number	:	872-235-0722
Fax Number	:	872-235-0730

Provider Business Practice Location Address
First Line	:	2545 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5296
Country	:	US
Telephone Number	:	773-769-0205
Fax Number	:	773-765-0801

Authorized Official
Title or Position	:	REVENUE CYCLE MANAGER
Name	:	KELLY DAVIS
Credential	:
Telephone Number	:	872-235-0258

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	04/08/2025

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