Provider Demographics
NPI:1194730788
Name:CONNECTIONS COUNSELING & CONSULTING SERVICES, INC.
Entity type:Organization
Organization Name:CONNECTIONS COUNSELING & CONSULTING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:CANEVELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-477-2270
Mailing Address - Street 1:610 CRYSTAL POINT DR STE 3
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-1400
Mailing Address - Country:US
Mailing Address - Phone:815-477-2270
Mailing Address - Fax:815-477-2287
Practice Address - Street 1:610 CRYSTAL POINT DR STE 3
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-1400
Practice Address - Country:US
Practice Address - Phone:815-477-2270
Practice Address - Fax:815-477-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5621709OtherBLUE CROSS/SHIELD #