Provider Demographics
NPI:1114006210
Name:CHATHAM PRESBYTERIAN CHURCH
Entity Type:Organization
Organization Name:CHATHAM PRESBYTERIAN CHURCH
Other - Org Name:CROSSROADS COUNSELING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:THURSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:217-483-1224
Mailing Address - Street 1:1835 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-1578
Mailing Address - Country:US
Mailing Address - Phone:217-483-1224
Mailing Address - Fax:217-483-7135
Practice Address - Street 1:1835 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-1578
Practice Address - Country:US
Practice Address - Phone:217-483-1224
Practice Address - Fax:217-483-7135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003064101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty