Provider Demographics
NPI:1902333651
Name:DEARBONE COUNSELING CENTER, INC
Entity Type:Organization
Organization Name:DEARBONE COUNSELING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DETRALL
Authorized Official - Middle Name:ARNELL
Authorized Official - Last Name:DEARBONE-COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:708-606-9895
Mailing Address - Street 1:54 N WOLF RD
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162-1630
Mailing Address - Country:US
Mailing Address - Phone:078-606-9895
Mailing Address - Fax:708-449-5953
Practice Address - Street 1:340 W BUTTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5069
Practice Address - Country:US
Practice Address - Phone:708-606-9895
Practice Address - Fax:708-449-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3556092641Medicaid