Organization
JEFFERSON PARK COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM KOCH (OWNER)
(773) 707-5833
Entity
Organization
Contact information
Practice address
5123 W AINSLIE ST, CHICAGO, IL 60630-2304
(773) 707-5833
Mailing address
5123 W AINSLIE ST, CHICAGO, IL 60630-2304
(773) 707-5833
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
12/28/2020
Last updated
12/28/2020
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