Basic Information
| Provider Information | |||||||||
| NPI: | 1386058196 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | YOUTH SERVICES OF GLENVIEW-NORTHBROOK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3080 W LAKE AVE | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600261210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477242620 | ||||||||
| FaxNumber: | 8477243499 | ||||||||
| Practice Location | |||||||||
| Address1: | 3080 W LAKE AVE | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600261210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477242620 | ||||||||
| FaxNumber: | 8477243499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2014 | ||||||||
| LastUpdateDate: | 06/19/2014 | ||||||||
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| AuthorizedOfficialLastName: | O'LEARY | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8477242620 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251V00000X | Y | Agencies | Voluntary or Charitable |
No ID Information.