Provider Demographics
NPI:1710042437
Name:COUNSELING CENTER OF LAKE VIEW
Entity Type:Organization
Organization Name:COUNSELING CENTER OF LAKE VIEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-549-5886
Mailing Address - Street 1:3225 N SHEFFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2210
Mailing Address - Country:US
Mailing Address - Phone:773-549-5886
Mailing Address - Fax:773-549-3265
Practice Address - Street 1:3225 N SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2210
Practice Address - Country:US
Practice Address - Phone:773-549-5886
Practice Address - Fax:773-549-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL005Medicaid