Provider Demographics
NPI:1457799926
Name:FIRST PRESBYTERIAN CHURCH
Entity Type:Organization
Organization Name:FIRST PRESBYTERIAN CHURCH
Other - Org Name:THE COUNSELING CENTER OF FPCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:MIYAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:REV, LPC
Authorized Official - Phone:847-864-9133
Mailing Address - Street 1:1427 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4726
Mailing Address - Country:US
Mailing Address - Phone:847-864-9133
Mailing Address - Fax:
Practice Address - Street 1:1427 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4726
Practice Address - Country:US
Practice Address - Phone:847-864-9133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST PRESBYTERIAN CHURCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-06
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center