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Organization

CENTER FOR CHANGE & HEALING

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. KEVIN KELL LCSW (DIRECTOR OF INFORMATION)
(630) 849-6212
Entity
Organization

Contact information

Practice address
11S230 S JACKSON ST STE 104, BURR RIDGE, IL 60527-7099
(630) 712-6042
Mailing address
11S230 S JACKSON ST STE 104, BURR RIDGE, IL 60527-7099
(630) 712-6042

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1003335076
NPI
IL
01
1023595238
NPI
IL
01
1174883862
NPI
IL
01
1598036386
NPI
IL
Enumeration date
10/29/2021
Last updated
10/29/2021
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