Provider Demographics
NPI:1003570565
Name:CENTER FOR CHANGE & HEALING
Entity Type:Organization
Organization Name:CENTER FOR CHANGE & HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INFORMATION
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-849-6212
Mailing Address - Street 1:11S230 S JACKSON ST STE 104
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7099
Mailing Address - Country:US
Mailing Address - Phone:630-712-6042
Mailing Address - Fax:
Practice Address - Street 1:11S230 S JACKSON ST STE 104
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-7099
Practice Address - Country:US
Practice Address - Phone:630-712-6042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003335076OtherNPI
IL1174883862OtherNPI
IL1023595238OtherNPI
IL1598036386OtherNPI