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Organization
PLCCA
Active
Organization
PLCCA
Active
Other names
Proviso Leyden Council for Community Action, INC.
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PAMELA M YATES (DATA/BILLING SPECIALIST)
(708) 450-3500
Entity
Organization
Contact information
Practice address
411 MADISON W ST, MAYWOOD, IL 60153-2136
(708) 450-3500
Mailing address
411 MADISON W ST, MAYWOOD, IL 60153-2136
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215987003
—
IL
Enumeration date
08/29/2013
Last updated
08/05/2022
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