Provider Demographics
NPI:1639241748
Name:FAMILY COUNSELING SERVICES OF NORTHERN IL
Entity Type:Organization
Organization Name:FAMILY COUNSELING SERVICES OF NORTHERN IL
Other - Org Name:FAMILY CONSULTATION SERVICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-962-5585
Mailing Address - Street 1:631 N LONGWOOD ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4263
Mailing Address - Country:US
Mailing Address - Phone:815-962-5585
Mailing Address - Fax:815-962-8945
Practice Address - Street 1:631 N LONGWOOD ST STE 103
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4263
Practice Address - Country:US
Practice Address - Phone:815-962-5585
Practice Address - Fax:815-962-8945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL314780OtherMEDICARE NEW
IL101-19312OtherBCBS