Provider Demographics
NPI:1659382521
Name:CENTER FOR CONTEXTUAL CHANGE
Entity Type:Organization
Organization Name:CENTER FOR CONTEXTUAL CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:847-676-4447
Mailing Address - Street 1:9239 GROSS POINT RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1389
Mailing Address - Country:US
Mailing Address - Phone:847-676-4447
Mailing Address - Fax:847-676-4450
Practice Address - Street 1:9239 GROSS POINT RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1389
Practice Address - Country:US
Practice Address - Phone:847-676-4447
Practice Address - Fax:847-676-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215537OtherMEDICARE PTAN
IL01620417OtherBLUECROSS/BLUESHIELD