Provider Demographics
NPI:1669749560
Name:CHICAGO COUNSELING CENTER, P.C.
Entity type:Organization
Organization Name:CHICAGO COUNSELING CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWENDORP
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-573-6569
Mailing Address - Street 1:6160 N CICERO AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4312
Mailing Address - Country:US
Mailing Address - Phone:773-932-9597
Mailing Address - Fax:773-243-0519
Practice Address - Street 1:6160 N CICERO AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4312
Practice Address - Country:US
Practice Address - Phone:773-932-9597
Practice Address - Fax:773-243-0519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-19
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007907101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty