Provider Demographics
NPI:1952687675
Name:TAYLOR COUNSELING CARE, LLC
Entity Type:Organization
Organization Name:TAYLOR COUNSELING CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, NCC
Authorized Official - Phone:312-520-1335
Mailing Address - Street 1:4248 W. 77TH STREET UNIT #301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-1378
Mailing Address - Country:US
Mailing Address - Phone:312-520-1335
Mailing Address - Fax:773-884-0490
Practice Address - Street 1:4248 W. 77TH STREET UNIT #301
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-1378
Practice Address - Country:US
Practice Address - Phone:312-520-1335
Practice Address - Fax:773-884-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007187251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health