| Lake County Crisis Center For The Prevention And Treatment Of Domestic | |
|
18391 W Washington St. Suite 300 Third Lake IL 60030 | |
| (847) 731-7165 | |
| Not Available |
| Full Name | Lake County Crisis Center For The Prevention And Treatment Of Domestic |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 18391 W Washington St., Third Lake, Illinois |
| Authorized Official Name and Position | Pat Davenport (CEO) |
| Authorized Official Contact | 8477317165 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake County Crisis Center For The Prevention And Treatment Of Domestic 2710 17th St Zion IL 60099-1543 Ph: (847) 731-7165 | Lake County Crisis Center For The Prevention And Treatment Of Domestic 18391 W Washington St. Suite 300 Third Lake IL 60030 Ph: (847) 731-7165 |
| NPI Number | 1720855943 |
|---|---|
| Provider Enumeration Date | 12/07/2023 |
| Last Update Date | 12/07/2023 |
| Certification Date | 12/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720855943 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |