Provider Demographics
NPI:1285181438
Name:THE CIRCLE EL CIRCULO OF THE SOCIETY OF HELPERS
Entity Type:Organization
Organization Name:THE CIRCLE EL CIRCULO OF THE SOCIETY OF HELPERS
Other - Org Name:THE CIRCLE OF THE SOCIETY OF HELPERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:872-444-5148
Mailing Address - Street 1:2648 W PERSHING RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-1629
Mailing Address - Country:US
Mailing Address - Phone:872-444-5148
Mailing Address - Fax:872-444-5148
Practice Address - Street 1:2648 W PERSHING RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-1629
Practice Address - Country:US
Practice Address - Phone:872-444-5148
Practice Address - Fax:872-444-5148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071002095103TC0700X
IL071-002095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1487735940Medicare PIN