Provider Demographics
NPI:1306294525
Name:LEYDEN DUPAGE COUNSELING SERVICE
Entity type:Organization
Organization Name:LEYDEN DUPAGE COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-368-9100
Mailing Address - Street 1:1010 JORIE BLVD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2215
Mailing Address - Country:US
Mailing Address - Phone:630-368-9100
Mailing Address - Fax:630-990-0506
Practice Address - Street 1:7350 W COLLEGE DR
Practice Address - Street 2:SUITE 108A
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1149
Practice Address - Country:US
Practice Address - Phone:630-368-9100
Practice Address - Fax:630-990-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010256101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty