Provider Demographics
NPI:1154671030
Name:ALLENDALE ASSOCIATION
Entity Type:Organization
Organization Name:ALLENDALE ASSOCIATION
Other - Org Name:BRADLEY COUNSELING CENTER - GURNEE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SCHRANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, JD
Authorized Official - Phone:847-245-6214
Mailing Address - Street 1:5465 GRAND AVE
Mailing Address - Street 2:101
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-4913
Mailing Address - Country:US
Mailing Address - Phone:847-244-7177
Mailing Address - Fax:847-244-9486
Practice Address - Street 1:5465 GRAND AVE
Practice Address - Street 2:101
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-4913
Practice Address - Country:US
Practice Address - Phone:847-244-7177
Practice Address - Fax:847-244-9486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0804X, 251S00000X, 261QM0801X
IL007261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========007Medicaid