Provider Demographics
NPI:1861571184
Name:EVANGELICAL CHILD AND FAMILY AGENCY
Entity type:Organization
Organization Name:EVANGELICAL CHILD AND FAMILY AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR AND PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT, LCPC
Authorized Official - Phone:630-653-6400
Mailing Address - Street 1:1530 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3584
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1530 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3584
Practice Address - Country:US
Practice Address - Phone:630-653-6400
Practice Address - Fax:630-653-6490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL006726-10251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable