Provider Demographics
NPI:1477286805
Name:PCK BEHAVIORAL HEALTH GROUP
Entity type:Organization
Organization Name:PCK BEHAVIORAL HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHETSAVANH
Authorized Official - Middle Name:C
Authorized Official - Last Name:COGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:224-699-0196
Mailing Address - Street 1:47 KATRINA LN
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:IL
Mailing Address - Zip Code:60118-3123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47 KATRINA LN
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:IL
Practice Address - Zip Code:60118-3123
Practice Address - Country:US
Practice Address - Phone:224-699-0196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-04
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty