Provider Demographics
NPI:1013228717
Name:COUNSELING CENTER OF LAKEVIEW
Entity Type:Organization
Organization Name:COUNSELING CENTER OF LAKEVIEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASEWORKER 4
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CHRYSTAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-549-5886
Mailing Address - Street 1:3225 N SHEFFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2210
Mailing Address - Country:US
Mailing Address - Phone:773-549-5886
Mailing Address - Fax:773-549-5892
Practice Address - Street 1:3225 N SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2210
Practice Address - Country:US
Practice Address - Phone:773-549-5886
Practice Address - Fax:773-549-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004932251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health