Basic Information
| Provider Information | |||||||||
| NPI: | 1962616904 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACCESS COUNSELING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18303 ROBIN LN | ||||||||
| Address2: | |||||||||
| City: | HOMEWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604302856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734198288 | ||||||||
| FaxNumber: | 7087991889 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 W. 177TH STREET | ||||||||
| Address2: | SUITE 3F | ||||||||
| City: | HAZEL CREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7984089125 | ||||||||
| FaxNumber: | 7087991889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 06/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | THURMAN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | EMIL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT CEO | ||||||||
| AuthorizedOfficialTelephone: | 7734198288 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149-007753 | IL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 55900C | 01 | IL | PSYCHEALTH | OTHER | 784444000 | 01 | IL | MAGELLAN | OTHER | 12278316 | 01 | IL | MULTIPLAN | OTHER | 9367411 | 01 | IL | PHCS PRIVATE HEALTH CARE | OTHER | 1634964 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER | 316653 | 01 | IL | MHN MANAGED HEALTH NETWOR | OTHER | 521834 | 01 | IL | VALUEOPTIONS | OTHER | T9190 | 01 | IL | APS | OTHER |