Provider Demographics
NPI:1104378579
Name:ADVANCED COUNSELING EVALUATION TREATMENT AND DUI SERVICES
Entity Type:Organization
Organization Name:ADVANCED COUNSELING EVALUATION TREATMENT AND DUI SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:BURASH
Authorized Official - Suffix:
Authorized Official - Credentials:CSADC
Authorized Official - Phone:815-343-5691
Mailing Address - Street 1:705 E LINCOLN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-6406
Mailing Address - Country:US
Mailing Address - Phone:309-808-1017
Mailing Address - Fax:
Practice Address - Street 1:705 E LINCOLN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-6406
Practice Address - Country:US
Practice Address - Phone:309-808-1017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA75150001A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health