Basic Information
| Provider Information | |||||||||
| NPI: | 1609240456 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALING CENTER FOR BEHAVIORAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1005 W LARAWAY RD | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | NEW LENOX | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604512461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085869303 | ||||||||
| FaxNumber: | 8662930414 | ||||||||
| Practice Location | |||||||||
| Address1: | 15127 S 73RD AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604624398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085869303 | ||||||||
| FaxNumber: | 8662930414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2015 | ||||||||
| LastUpdateDate: | 11/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | SKAS | ||||||||
| AuthorizedOfficialFirstName: | SHELLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | LICENSED CLINICAL PROFESSIONAL COUN | ||||||||
| AuthorizedOfficialTelephone: | 7085869303 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 180007474 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.