Provider Demographics
NPI:1508147109
Name:EVANGELICAL CHILD AND FAMILY AGENCY
Entity Type:Organization
Organization Name:EVANGELICAL CHILD AND FAMILY AGENCY
Other - Org Name:ECFA COUNSELING CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENTON
Authorized Official - Middle Name:J
Authorized Official - Last Name:WITHROW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:639-653-6400
Mailing Address - Street 1:1530 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3584
Mailing Address - Country:US
Mailing Address - Phone:630-653-6400
Mailing Address - Fax:630-653-6490
Practice Address - Street 1:2240 W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4881
Practice Address - Country:US
Practice Address - Phone:312-421-6200
Practice Address - Fax:312-421-6298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL006726-11253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2BO5IPI16Medicaid