NPIMap

Organization Active NPI

Haven Youth and Family Services

  • Professional Counselor
  • Wilmette, IL
National Provider Identifier
1164864302
Registry record updated Jul 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
149013375 Issued in IL
Legal business name
HAVEN YOUTH AND FAMILY SERVICES
Practice address
825 Green Bay Rd
Suite 200
Wilmette, IL 60091-2597
Phone
(847) 251-6630
Fax
(815) 521-1889
NPI assigned
Jul 29, 2013
Last updated
Jul 29, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2013

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

Authorized official

Name
Charley Smith, LCSW
Title
Director
Phone
(847) 251-6630

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 149013375 IL Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X IL

Addresses

Primary practice location

825 Green Bay Rd
Suite 200
Wilmette, IL 60091-2597

Mailing address

PO Box 613
Channahon, IL 60410-0613
Phone (815) 521-1889

National Provider Directory

National Provider Directory

Locations

825 Green Bay Rd
Ste 200
Wilmette, IL 60091
Phone (847) 251-6630

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1375056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375056000000",
    "number": "1164864302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 613",
            "city": "CHANNAHON",
            "state": "IL",
            "postal_code": "604100613",
            "telephone_number": "815-521-1889",
            "fax_number": "815-521-1889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 GREEN BAY RD",
            "address_2": "SUITE 200",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912597",
            "telephone_number": "847-251-6630",
            "fax_number": "815-521-1889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN YOUTH AND FAMILY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-29",
        "last_updated": "2013-07-29",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CHARLEY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "847-251-6630",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "149013375",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmette, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2013; 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.