Organization
BLUE ISLAND COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN CHRISTOPHER KOZAK LCPC (CEO)
(708) 829-5673
Entity
Organization
Contact information
Practice address
2343 CANAL ST, BLUE ISLAND, IL 60406-2956
(708) 674-8735
Mailing address
2343 CANAL ST, BLUE ISLAND, IL 60406-2956
(708) 674-8735
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972054294
—
IL
Enumeration date
12/16/2019
Last updated
12/16/2019
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