Provider Demographics
NPI:1144931023
Name:OUTREACH COUNSELING CENTER YORK
Entity type:Organization
Organization Name:OUTREACH COUNSELING CENTER YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL ADMIN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-871-2100
Mailing Address - Street 1:373 S SCHMALE RD
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2774
Mailing Address - Country:US
Mailing Address - Phone:630-682-1910
Mailing Address - Fax:
Practice Address - Street 1:1S450 SUMMIT AVE STE 315
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3990
Practice Address - Country:US
Practice Address - Phone:630-682-1910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUTREACH COMMUNITY MINISTRIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-12
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health