Provider Demographics
NPI:1710398904
Name:ST MICHAELS COUNSELING CENTER
Entity Type:Organization
Organization Name:ST MICHAELS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIANIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-598-8540
Mailing Address - Street 1:7124 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-2805
Mailing Address - Country:US
Mailing Address - Phone:773-598-8540
Mailing Address - Fax:
Practice Address - Street 1:7124 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-2805
Practice Address - Country:US
Practice Address - Phone:773-598-8540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-10
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-8254-0001-A251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health