Provider Demographics
NPI:1497842983
Name:SAMARITAN INTERFAITH COUNSELING CENTER INC.
Entity Type:Organization
Organization Name:SAMARITAN INTERFAITH COUNSELING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-357-2456
Mailing Address - Street 1:1819 BAY SCOTT CIR STE 109
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1130
Mailing Address - Country:US
Mailing Address - Phone:630-357-2456
Mailing Address - Fax:630-357-2482
Practice Address - Street 1:1819 BAY SCOTT CIR STE 109
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1130
Practice Address - Country:US
Practice Address - Phone:630-357-2456
Practice Address - Fax:630-357-2482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004701103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID