1215113063 NPI number — THE OAKS COUNSELING CENTER, INC.

Table of content: MARY CATHERINE KELLY PNP (NPI 1306058714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215113063 NPI number — THE OAKS COUNSELING CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE OAKS COUNSELING CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215113063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1234
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALATINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60078-1234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
236 W NORTHWEST HWY
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
BARRINGTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60010-3195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-329-6709
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LIEBOLD
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-329-6709

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1245414465 . This is a "NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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