Provider Demographics
NPI:1225743933
Name:ALLEN'S FAMILY COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:ALLEN'S FAMILY COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS,QMHP, CADC, CODP1
Authorized Official - Phone:708-728-5470
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:
Practice Address - Street 1:16700 SOUTH HALSTED ST
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-6065
Practice Address - Country:US
Practice Address - Phone:312-912-7008
Practice Address - Fax:312-533-2842
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLEN'S FAMILY COUNSELING CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7512-0001Medicaid