Provider Demographics
NPI:1255648697
Name:ANN L CHAN COUNSELING SERVICES, PC
Entity type:Organization
Organization Name:ANN L CHAN COUNSELING SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MEDUC,MSW
Authorized Official - Phone:217-390-2917
Mailing Address - Street 1:2203 S ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-6711
Mailing Address - Country:US
Mailing Address - Phone:217-390-2917
Mailing Address - Fax:217-355-1866
Practice Address - Street 1:206 N RANDOLPH ST STE 420
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3978
Practice Address - Country:US
Practice Address - Phone:217-390-2917
Practice Address - Fax:217-355-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health