South Side Christian Counseling Center Group

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Legal business name

SOUTH SIDE CHRISTIAN COUNSELING CENTER GROUP

Practice address

16537 Oak Park Ave.
Tinley Park, IL 60477

Phone

(708) 633-9003

Fax

(708) 633-1823

NPI assigned

Aug 1, 2006

Last updated

Jun 12, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jeffrey S Hauser

Title

President

Phone

(712) 887-0399

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Southside Christian Counseling Center Former legal business name

Locations

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434067200000",
    "number": "1679589220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 MAIN ST.",
            "city": "LOHRVILLE",
            "state": "IA",
            "postal_code": "51453",
            "telephone_number": "712-887-0399",
            "fax_number": "708-633-1823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16537 OAK PARK AVE.",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "60477",
            "telephone_number": "708-633-9003",
            "fax_number": "708-633-1823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SIDE CHRISTIAN COUNSELING CENTER GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2015-06-12",
        "status": "A",
        "authorized_official_last_name": "HAUSER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "712-887-0399",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "180-003931",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA INSURANCE",
            "identifier": "7092108",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1618179",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southside Christian Counseling Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Southside Christian Counseling Center
• Southside Counseling Services, LLC

• Marriage & Family Therapist in Tinley Park, IL
• Providers in Tinley Park, IL by specialty
• Marriage & Family Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2015; 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.