Provider Demographics
NPI:1255136396
Name:DEPTH COUNSELING SERVICES P C
Entity type:Organization
Organization Name:DEPTH COUNSELING SERVICES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RIZZOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-588-0654
Mailing Address - Street 1:122 S MICHIGAN AVE STE 1441
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-6173
Mailing Address - Country:US
Mailing Address - Phone:312-786-4990
Mailing Address - Fax:
Practice Address - Street 1:82 WENDELL AVE STE 100
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:312-786-4990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPTH COUNSELING SERVICES P C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health