Provider Demographics
NPI:1518026434
Name:BRADEN COUNSELING CENTER, P.C.
Entity Type:Organization
Organization Name:BRADEN COUNSELING CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRADEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:815-787-9000
Mailing Address - Street 1:2600 DEKALB AVENUE
Mailing Address - Street 2:SUITE I
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178
Mailing Address - Country:US
Mailing Address - Phone:815-787-9000
Mailing Address - Fax:815-787-9015
Practice Address - Street 1:2600 DEKALB AVENUE
Practice Address - Street 2:SUITE I
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178
Practice Address - Country:US
Practice Address - Phone:815-787-9000
Practice Address - Fax:815-787-9015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA74100001A101YM0800X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01932029OtherBLUECROSSBLUE SHIELD
IL01932029OtherBLUECROSSBLUE SHIELD