Provider Demographics
NPI:1598927436
Name:BROWNDEER FAMILY SERVICES, INC
Entity Type:Organization
Organization Name:BROWNDEER FAMILY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:815-877-9999
Mailing Address - Street 1:7120 WINDSOR LAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-3803
Mailing Address - Country:US
Mailing Address - Phone:815-877-9999
Mailing Address - Fax:815-877-2601
Practice Address - Street 1:7120 WINDSOR LAKE PKWY
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-3803
Practice Address - Country:US
Practice Address - Phone:815-877-9999
Practice Address - Fax:815-877-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071033575101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL568620Medicare PIN