Provider Demographics
NPI:1871857615
Name:INDIVIDUAL AND FAMILY CONNECTION, LLC
Entity Type:Organization
Organization Name:INDIVIDUAL AND FAMILY CONNECTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:773-270-0469
Mailing Address - Street 1:1806 N DAMEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5511
Mailing Address - Country:US
Mailing Address - Phone:773-270-0469
Mailing Address - Fax:
Practice Address - Street 1:1806 N DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5511
Practice Address - Country:US
Practice Address - Phone:773-270-0469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty