1649573080 NPI number — COUNSELING AND CONSULTING SERVICES, P.C.

Table of content: (NPI 1649573080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649573080 NPI number — COUNSELING AND CONSULTING SERVICES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNSELING AND CONSULTING SERVICES, P.C.
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:
1649573080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1035 GROVE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515-4636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-926-7378
Provider Business Mailing Address Fax Number:
630-852-6335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1035 GROVE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOWNERS GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60515-4636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-926-4873
Provider Business Practice Location Address Fax Number:
630-852-6335
Provider Enumeration Date:
12/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FABER
Authorized Official First Name:
DALE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
630-926-4873

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2223316 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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