Provider Demographics
NPI:1740430172
Name:INSTITUTE FOR MARRIAGE AND FAMILY COUNSELING
Entity Type:Organization
Organization Name:INSTITUTE FOR MARRIAGE AND FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-562-9353
Mailing Address - Street 1:1000 JORIE BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2214
Mailing Address - Country:US
Mailing Address - Phone:815-562-9353
Mailing Address - Fax:
Practice Address - Street 1:1000 JORIE BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2214
Practice Address - Country:US
Practice Address - Phone:815-562-9353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002033101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty