Provider Demographics
NPI:1063822823
Name:HEURISTIC QUEST HEADQUARTERS
Entity Type:Organization
Organization Name:HEURISTIC QUEST HEADQUARTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:R
Authorized Official - Last Name:EASON-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC CADC
Authorized Official - Phone:773-238-5555
Mailing Address - Street 1:1708 W BEVERLY GLEN PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1408
Mailing Address - Country:US
Mailing Address - Phone:773-238-5555
Mailing Address - Fax:773-238-5533
Practice Address - Street 1:1222 W. 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1408
Practice Address - Country:US
Practice Address - Phone:773-238-5555
Practice Address - Fax:773-238-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
IL180-005158251S00000X
IL13958251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management