1962616904 NPI number — ACCESS COUNSELING CENTER

Table of content: (NPI 1962616904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962616904 NPI number — ACCESS COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCESS COUNSELING CENTER
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:
1962616904
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18303 ROBIN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMEWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60430-2856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-419-8288
Provider Business Mailing Address Fax Number:
708-799-1889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 W. 177TH STREET
Provider Second Line Business Practice Location Address:
SUITE 3F
Provider Business Practice Location Address City Name:
HAZEL CREST
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
798-408-9125
Provider Business Practice Location Address Fax Number:
708-799-1889
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THURMAN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
EMIL
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
773-419-8288

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149-007753 , 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: 55900C . This is a "PSYCHEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 784444000 . This is a "MAGELLAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 12278316 . This is a "MULTIPLAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 9367411 . This is a "PHCS PRIVATE HEALTH CARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1634964 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 316653 . This is a "MHN MANAGED HEALTH NETWOR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 521834 . This is a "VALUEOPTIONS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: T9190 . This is a "APS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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