Provider Demographics
NPI:1417077538
Name:SAFE HARBOR CHICAGO NORTH
Entity Type:Organization
Organization Name:SAFE HARBOR CHICAGO NORTH
Other - Org Name:SAFE HARBOR CHRISTIAN COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-223-3561
Mailing Address - Street 1:2213 N SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-4049
Mailing Address - Country:US
Mailing Address - Phone:847-245-3567
Mailing Address - Fax:847-245-3573
Practice Address - Street 1:217 GOODNOW BLVD
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-3217
Practice Address - Country:US
Practice Address - Phone:847-223-2561
Practice Address - Fax:847-245-3573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty