Notre Dame Family Centers, Inc.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

NOTRE DAME FAMILY CENTERS, INC.

Practice address

12919 S 86TH Ave
Palos Park, IL 60464-1818

Phone

(505) 204-8404

NPI assigned

Aug 24, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michele Watzke Johnson, EDD, BCPC, LMFT

Title

Chief Operating Officer

Phone

(708) 671-8199

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1033636675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12919 S 86TH AVE",
            "city": "PALOS PARK",
            "state": "IL",
            "postal_code": "604641818",
            "telephone_number": "708-671-8199",
            "fax_number": "312-277-3544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12919 S 86TH AVE",
            "city": "PALOS PARK",
            "state": "IL",
            "postal_code": "604641818",
            "telephone_number": "505-204-8404"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1S376 Summit Ave Ste 5D",
            "address_purpose": "LOCATION",
            "city": "Oakbrook Terrace",
            "state": "IL",
            "postal_code": "601813968",
            "country_code": "US",
            "telephone_number": "630-691-1114",
            "fax_number": "630-691-1132",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 E Randolph St Apt 3230",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606015060",
            "country_code": "US",
            "telephone_number": "312-861-0651",
            "fax_number": "312-277-3544",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOTRE DAME FAMILY CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-24",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "WATZKE",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "708-671-8199",
        "authorized_official_credential": "EDD, BCPC, LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Palos Park, IL
• Providers in Palos Park, IL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.