Provider Demographics
NPI:1083759534
Name:DEPAUL FAMILY & COMMUNITY SERVICES
Entity Type:Organization
Organization Name:DEPAUL FAMILY & COMMUNITY SERVICES
Other - Org Name:DEPAUL UNIVERSITY COMMUNITY MENTAL HEALTH CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ORSON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-325-7780
Mailing Address - Street 1:2219 N KENMORE AVE
Mailing Address - Street 2:ROOM 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3504
Mailing Address - Country:US
Mailing Address - Phone:773-325-7780
Mailing Address - Fax:773-325-7781
Practice Address - Street 1:2219 N KENMORE AVE
Practice Address - Street 2:ROOM 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3504
Practice Address - Country:US
Practice Address - Phone:773-325-7780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPAUL UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-21
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)