Provider Demographics
NPI:1689862807
Name:NORTHERN ILLINOIS COUNSELING ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:NORTHERN ILLINOIS COUNSELING ASSOCIATES, P.C.
Other - Org Name:NICA
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-455-6736
Mailing Address - Street 1:600 SPRING HILL RING RD STE 116
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-7301
Mailing Address - Country:US
Mailing Address - Phone:815-455-6736
Mailing Address - Fax:815-455-9477
Practice Address - Street 1:600 SPRING HILL RING RD STE 116
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-7301
Practice Address - Country:US
Practice Address - Phone:815-455-6736
Practice Address - Fax:815-455-9477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004053103TC0700X
IL071-003663103TC0700X
IL149-0035341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005615149OtherBCBS
388190Medicare PIN