14D2248736 CLIA NUMBER - GLOBAL EXECUTIVE COUNCIL SERVICES

Laboratory Demographics

CLIA Number: 14D2248736

Facility Name: GLOBAL EXECUTIVE COUNCIL SERVICES

Facility Address:
5812 N LINCOLN AVE
CHICAGO, IL
ZIP 60659
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Facility Phone Number: 872 806-2066

Facility Type: Independent

Certificate Type: Waiver

NPI Number: 1962034488

Taxonomy: 261QM0855X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.

CLIA Record

Field Name	Field Value
CLIA Number	14D2248736
LAB Type	Independent
Facility Name	GLOBAL EXECUTIVE COUNCIL SERVICES
Street	5812 N LINCOLN AVE
City	CHICAGO
State	IL
ZIP	60659
Phone	872 806-2066
CertificateType	4
CertificateEffectiveDate	1/16/2024
CertificateExpirationDate	1/15/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024