Provider Demographics
NPI:1275383408
Name:CENTER FOR GROWTH AND CONNECTION
Entity Type:Organization
Organization Name:CENTER FOR GROWTH AND CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GABEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-927-7055
Mailing Address - Street 1:1913 S STATE ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2923
Mailing Address - Country:US
Mailing Address - Phone:708-927-7055
Mailing Address - Fax:
Practice Address - Street 1:1100 LAKE ST STE 255A
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1015
Practice Address - Country:US
Practice Address - Phone:708-927-7055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)