Organization
CITY OF CHICAGO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW W. BEAUDET (FIRST DEPUTY COMMISIONER)
(312) 747-9889
Entity
Organization
Contact information
Practice address
641 W 63RD ST, L33, CHICAGO, IL 60621-2032
(312) 747-7496
Mailing address
333 S. STATE ST, CHICAGO, IL 60604-3900
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
149008082
IL
Other
Enumeration date
06/30/2010
Last updated
06/30/2010
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