Provider Demographics
NPI:1922370527
Name:PARENTS WITH PROMISE LLC
Entity Type:Organization
Organization Name:PARENTS WITH PROMISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-758-1358
Mailing Address - Street 1:810 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-4410
Mailing Address - Country:US
Mailing Address - Phone:815-758-1358
Mailing Address - Fax:815-758-1580
Practice Address - Street 1:810 S 4TH ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-4410
Practice Address - Country:US
Practice Address - Phone:815-758-1358
Practice Address - Fax:815-758-1580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health