Provider Demographics
NPI:1164572459
Name:FIRST BAPTIST COUNSELIGN SERVICES
Entity Type:Organization
Organization Name:FIRST BAPTIST COUNSELIGN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:POLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-695-8700
Mailing Address - Street 1:1735 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5056
Mailing Address - Country:US
Mailing Address - Phone:847-695-8700
Mailing Address - Fax:
Practice Address - Street 1:1735 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5056
Practice Address - Country:US
Practice Address - Phone:847-695-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4598162OtherBCBS