Provider Demographics
NPI:1235255993
Name:DUNHAM COUNSELING CENTER, LTD.
Entity Type:Organization
Organization Name:DUNHAM COUNSELING CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-444-1801
Mailing Address - Street 1:451 DUNHAM RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1431
Mailing Address - Country:US
Mailing Address - Phone:630-444-1801
Mailing Address - Fax:630-444-1802
Practice Address - Street 1:451 DUNHAM RD
Practice Address - Street 2:SUITE 400
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1431
Practice Address - Country:US
Practice Address - Phone:630-444-1801
Practice Address - Fax:630-444-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0122961041C0700X
IL149.0055831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty