Provider Demographics
NPI:1083160584
Name:PILLAR INTERVENTIONS
Entity Type:Organization
Organization Name:PILLAR INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-808-0793
Mailing Address - Street 1:16943 GLEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-2149
Mailing Address - Country:US
Mailing Address - Phone:773-742-5663
Mailing Address - Fax:
Practice Address - Street 1:222 US HIGHWAY 41 STE 207
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1275
Practice Address - Country:US
Practice Address - Phone:219-808-0793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3300867A101YM0800X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty