Provider Demographics
NPI:1043229909
Name:CATHOLIC CHARITIES COUNSELING
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES COUNSELING
Other - Org Name:CATHOLIC CHARITIES - DIOCESE OF ROCKFORD
Other - Org Type:Other Name
Authorized Official - Title/Position:ASST. DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-965-0623
Mailing Address - Street 1:102 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-1102
Mailing Address - Country:US
Mailing Address - Phone:815-965-0623
Mailing Address - Fax:815-962-9036
Practice Address - Street 1:102 S MADISON ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-1102
Practice Address - Country:US
Practice Address - Phone:815-965-0623
Practice Address - Fax:815-962-9036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10132028OtherBLUE CROSS/BLUE SHIELD