| Community Counseling Centers Of Chicago | |
|
4740 N Clark St Chicago IL 60640-4689 | |
| (773) 769-0205 | |
| (773) 765-0801 |
| Full Name | Community Counseling Centers Of Chicago |
|---|---|
| Speciality | Clinic/Center |
| Location | 4740 N Clark St, Chicago, Illinois |
| Authorized Official Name and Position | Anthony A Kopera (PRESIDENT & CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7737690205 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Counseling Centers Of Chicago 4740 N. Clark St. Chicago IL 60640 Ph: (773) 769-0205 | Community Counseling Centers Of Chicago 4740 N Clark St Chicago IL 60640-4689 Ph: (773) 769-0205 |
| NPI Number | 1083634901 |
|---|---|
| Provider Enumeration Date | 07/21/2006 |
| Last Update Date | 04/20/2008 |
| Medicare PECOS PAC ID | 0244125508 |
|---|---|
| Medicare Enrollment ID | O20040217000382 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083634901 | NPI | - | NPPES |
| 1616824 | Other | IL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 04029 (Illinois) | Primary |
| Provider Name | Tarik M Qazzaz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598014797 PECOS PAC ID: 2961728514 Enrollment ID: I20150226000790 |
| Provider Name | Elizabeth R Tulsky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407384464 PECOS PAC ID: 7113293903 Enrollment ID: I20171023001911 |
Philip K Mccullough Md Sc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 201 E Huron St, Suite 11-100, Chicago, IL 60611 Phone: 312-695-3680 Fax: 312-926-3709 | |
Amy Lynn, Lcpc, Atr Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3020 N Lincoln Ave, Flourish Studios, Chicago, IL 60657 Phone: 773-746-7429 | |
K.a.m Alliance, Inc. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2215 W 95th St Ste 100, Chicago, IL 60643 Phone: 773-239-9600 Fax: 773-239-9601 | |
King Community Mental Health Center Corp Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4455 S King Drive, Suite 101, Chicago, IL 60653 Phone: 773-536-2700 Fax: 773-751-2250 | |
Young Adult Program Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4219 N Lincoln Ave, Chicago, IL 60618 Phone: 773-572-5500 Fax: 773-537-3488 | |
Professional Diagnostic Service, S.c. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 821 W Van Buren St, Chicago, IL 60607 Phone: 312-491-0404 Fax: 312-491-0505 | |
Universal Medical Group Ltd. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 809 E 42nd Pl, Chicago, IL 60653 Phone: 773-285-3422 |