Provider Demographics
NPI:1063401206
Name:CENTRAL DUPAGE PASTORAL COUNSELING CENTER
Entity type:Organization
Organization Name:CENTRAL DUPAGE PASTORAL COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-752-9750
Mailing Address - Street 1:507 THORNHILL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2706
Mailing Address - Country:US
Mailing Address - Phone:630-752-9750
Mailing Address - Fax:630-752-9768
Practice Address - Street 1:507 THORNHILL DR
Practice Address - Street 2:SUITE A
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2706
Practice Address - Country:US
Practice Address - Phone:630-752-9750
Practice Address - Fax:630-752-9768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178002569103TC0700X
IL071004746103TC0700X
106H00000X, 101YP1600X, 101YP2500X
IL178001992101YP2500X
IL180005369101YP2500X
IL180002208101YP2500X
IL071006345103TC0700X
IL071006372103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty