| Blue Island Counseling Llc | |
|
2343 Canal St Blue Island IL 60406-2956 | |
| (708) 674-8735 | |
| Not Available |
| Full Name | Blue Island Counseling Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2343 Canal St, Blue Island, Illinois |
| Authorized Official Name and Position | Justin Christopher Kozak (CEO) |
| Authorized Official Contact | 7088295673 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Island Counseling Llc 2343 Canal St Blue Island IL 60406-2956 Ph: (708) 674-8735 | Blue Island Counseling Llc 2343 Canal St Blue Island IL 60406-2956 Ph: (708) 674-8735 |
| NPI Number | 1740828284 |
|---|---|
| Provider Enumeration Date | 12/16/2019 |
| Last Update Date | 12/16/2019 |
| Certification Date | 12/16/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740828284 | NPI | - | NPPES |
| 1972054294 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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