Provider Demographics
NPI:1487770798
Name:YOUTH & FAMILY COUNSELING
Entity type:Organization
Organization Name:YOUTH & FAMILY COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:847-748-0385
Mailing Address - Street 1:1113 S MILWAUKEE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3758
Mailing Address - Country:US
Mailing Address - Phone:847-367-5991
Mailing Address - Fax:847-367-5997
Practice Address - Street 1:1113 S MILWAUKEE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3758
Practice Address - Country:US
Practice Address - Phone:847-367-5991
Practice Address - Fax:847-367-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL325770Medicare UPIN
IL325770Medicare ID - Type Unspecified
IL533260Medicare ID - Type Unspecified
IL328100Medicare ID - Type Unspecified