Provider Demographics
NPI:1861572240
Name:ALPHA COUNSELING CENTER INC
Entity type:Organization
Organization Name:ALPHA COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KULLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS LCPC
Authorized Official - Phone:630-983-4577
Mailing Address - Street 1:1112 S WASHINGTON ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7999
Mailing Address - Country:US
Mailing Address - Phone:630-983-4577
Mailing Address - Fax:630-983-4690
Practice Address - Street 1:1112 S WASHINGTON ST
Practice Address - Street 2:SUITE 14
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7999
Practice Address - Country:US
Practice Address - Phone:630-983-4577
Practice Address - Fax:630-983-4690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932149OtherBLUECROSSBLUESHIELD OF IL