NPIMap

Organization Active NPI

Southside Christian Counseling Center

  • Professional Counselor
  • Tinley Park, IL
National Provider Identifier
1861790883
Registry record updated Mar 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
178.005263 Issued in IL
Legal business name
SOUTHSIDE CHRISTIAN COUNSELING CENTER
Practice address
16547 Oak Park Ave
Tinley Park, IL 60477-1752
Phone
(708) 633-9003
Fax
(708) 633-1823
NPI assigned
Mar 1, 2011
Last updated
Mar 1, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2011

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

Authorized official

Name
Mrs. Linda Koehne
Title
Office Manager
Phone
(708) 633-9003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X 178.005263 IL Primary

Addresses

Primary practice location

16547 Oak Park Ave
Tinley Park, IL 60477-1752

Mailing address

16547 Oak Park Ave
Tinley Park, IL 60477-1752
Phone (708) 633-9003

National Provider Directory

National Provider Directory

Locations

16547 Oak Park Ave
Tinley Park, IL 60477
Phone (708) 532-0330

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1298937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298937600000",
    "number": "1861790883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16547 OAK PARK AVE",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604771752",
            "telephone_number": "708-633-9003",
            "fax_number": "708-633-1823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16547 OAK PARK AVE",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604771752",
            "telephone_number": "708-633-9003",
            "fax_number": "708-633-1823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE CHRISTIAN COUNSELING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-01",
        "last_updated": "2011-03-01",
        "status": "A",
        "authorized_official_last_name": "KOEHNE",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "708-633-9003",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178.005263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tinley Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2011; 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.