Organization
YOUTH SERVICE BUREAU
Active
Other names
LPC
Organization subpart
No
Provider details
NPI number
Authorized official
CALVERT WILLIAMS (STAFF)
(773) 906-6690
Entity
Organization
Contact information
Practice address
1525 E 53RD ST, CHICAGO, IL 60615-4557
(773) 906-6690
Mailing address
1525 E 53RD ST, CHICAGO, IL 60615-4557
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
748284589576
—
IL
05
—
749278592R
—
IL
Enumeration date
02/06/2023
Last updated
02/23/2024
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