Provider Demographics
NPI:1083128474
Name:ABC COUNSELING & FAMILY SERVICES
Entity Type:Organization
Organization Name:ABC COUNSELING & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, FORMER EXEC DIR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCPC, LSOE, LS
Authorized Official - Phone:309-451-9495
Mailing Address - Street 1:705 E. LINCOLN ST
Mailing Address - Street 2:STE 303
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 W. WASHINGTON ST.
Practice Address - Street 2:SUITE 410B
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611
Practice Address - Country:US
Practice Address - Phone:309-694-1596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABC COUNSELING AND FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198405261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)