Basic Information
| Provider Information | |||||||||
| NPI: | 1801313721 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | S S BEHAVIORAL HEALTH INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1415 S ARDMORE AVE UNIT 7020 | ||||||||
| Address2: | |||||||||
| City: | VILLA PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601815871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303174360 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2625 BUTTERFIELD RD STE 138S | ||||||||
| Address2: | |||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302902246 | ||||||||
| FaxNumber: | 7736355757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SIDDIQUI | ||||||||
| AuthorizedOfficialFirstName: | MOHAMMED | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6302902246 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0805X | 036-131386 | IL | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | 2084P0800X | 036-131386 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.