Provider Demographics
NPI:1689117640
Name:ABC COUNSELING AND FAMILY SERVICES
Entity type:Organization
Organization Name:ABC COUNSELING AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:639-451-9495
Mailing Address - Street 1:1110 ARBOR DR
Mailing Address - Street 2:STE C
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-9285
Mailing Address - Country:US
Mailing Address - Phone:217-877-9217
Mailing Address - Fax:217-877-9218
Practice Address - Street 1:1110 ARBOR DR
Practice Address - Street 2:STE C
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-9285
Practice Address - Country:US
Practice Address - Phone:217-877-9217
Practice Address - Fax:217-877-9218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2A00-IPI-175Medicaid