Provider Demographics
NPI:1295004018
Name:COUNSELING CENTER FOR EMOTIONAL GROWTH
Entity Type:Organization
Organization Name:COUNSELING CENTER FOR EMOTIONAL GROWTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GEORGETTE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:LE PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:847-967-0952
Mailing Address - Street 1:5225 OLD ORCHARD RD
Mailing Address - Street 2:SUITE 29
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-4405
Mailing Address - Country:US
Mailing Address - Phone:847-967-0952
Mailing Address - Fax:312-643-1341
Practice Address - Street 1:5225 OLD ORCHARD RD
Practice Address - Street 2:SUITE 29
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4405
Practice Address - Country:US
Practice Address - Phone:847-967-0952
Practice Address - Fax:312-643-1341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-00239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty