Provider Demographics
NPI:1164919254
Name:ALLEN'S FAMILY COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:ALLEN'S FAMILY COUNSELING CENTER, INC.
Other - Org Name:ALLEN'S FAMILY COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-912-7008
Mailing Address - Street 1:226 W ONTARIO ST STE 400C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3619
Mailing Address - Country:US
Mailing Address - Phone:312-912-7008
Mailing Address - Fax:312-533-2842
Practice Address - Street 1:226 W ONTARIO ST STE 400C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3619
Practice Address - Country:US
Practice Address - Phone:708-728-5470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-7512-0001-A101YA0400X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7512-0001Medicaid