Organization
COMMUNITY COUNSELING CENTERS OF CHICAGO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY A KOPERA PHD (PRESIDENT & CHIEF EXECUTIVE OFFICER)
(773) 769-0205
Entity
Organization
Contact information
Practice address
4740 N CLARK ST, CHICAGO, IL 60640-4689
(773) 769-0205
(773) 765-0801
Mailing address
4740 N. CLARK ST., CHICAGO, IL 60640
(773) 769-0205
(773) 765-0801
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
04029
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1616824
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/21/2006
Last updated
04/20/2008
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