Provider Demographics
NPI:1972995363
Name:THE INSTITUTE FOR COUNSELING AND PERSONAL DEVELOPMENT
Entity Type:Organization
Organization Name:THE INSTITUTE FOR COUNSELING AND PERSONAL DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:OLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-951-2570
Mailing Address - Street 1:1020 MILWAUKEE AVE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3513
Mailing Address - Country:US
Mailing Address - Phone:847-951-2570
Mailing Address - Fax:
Practice Address - Street 1:1020 MILWAUKEE AVE
Practice Address - Street 2:SUITE 255
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3513
Practice Address - Country:US
Practice Address - Phone:847-951-2570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE NEW REFORM CONGREGATION KADIMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.006411251S00000X
IL178.010376251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1980Medicare UPIN