Provider Demographics
NPI:1063659423
Name:SAMARITAN COUNSELING CENTER OF THE NORTHWEST SUBURBS
Entity Type:Organization
Organization Name:SAMARITAN COUNSELING CENTER OF THE NORTHWEST SUBURBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PROFESSIONAL COUN
Authorized Official - Prefix:DR
Authorized Official - First Name:LORA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WIENS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-382-4673
Mailing Address - Street 1:800 HART RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2671
Mailing Address - Country:US
Mailing Address - Phone:847-382-4673
Mailing Address - Fax:
Practice Address - Street 1:800 HART RD
Practice Address - Street 2:SUITE 250
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2671
Practice Address - Country:US
Practice Address - Phone:847-382-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty