Provider Demographics
NPI:1720090780
Name:ST JAMES CATHEDRAL COUNSELING CENTER
Entity type:Organization
Organization Name:ST JAMES CATHEDRAL COUNSELING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PREBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-337-5874
Mailing Address - Street 1:50 E WASHINGTON ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2152
Mailing Address - Country:US
Mailing Address - Phone:312-252-9500
Mailing Address - Fax:312-337-9243
Practice Address - Street 1:50 E WASHINGTON ST
Practice Address - Street 2:SUITE 301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2152
Practice Address - Country:US
Practice Address - Phone:312-252-9500
Practice Address - Fax:312-337-9243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0160-8726OtherBC/BS PROVIDER NUMBER
IL341410Medicare ID - Type UnspecifiedMEDICARE NUMBER