Provider Demographics
NPI:1861427387
Name:A.S.S.I.S.T. OF PALOS HEIGHTS, INC.
Entity type:Organization
Organization Name:A.S.S.I.S.T. OF PALOS HEIGHTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWNMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:708-261-3544
Mailing Address - Street 1:7808 W COLLEGE DR
Mailing Address - Street 2:LOWER LEVEL STE 3
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1027
Mailing Address - Country:US
Mailing Address - Phone:708-261-3544
Mailing Address - Fax:708-361-4460
Practice Address - Street 1:7808 W COLLEGE DR
Practice Address - Street 2:LOWER LEVEL STE 3
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1027
Practice Address - Country:US
Practice Address - Phone:708-261-3544
Practice Address - Fax:708-361-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty