Basic Information
Provider Information
NPI: 1841646122
EntityType: 2
ReplacementNPI:  
OrganizationName: PRESENCE BEHAVIORAL HEALTH
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9855 W ROOSEVELT RD
Address2:  
City: WESTCHESTER
State: IL
PostalCode: 601542758
CountryCode: US
TelephoneNumber: 7086812325
FaxNumber:  
Practice Location
Address1: 9855 W ROOSEVELT RD
Address2:  
City: WESTCHESTER
State: IL
PostalCode: 601542758
CountryCode: US
TelephoneNumber: 7086812325
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/05/2016
LastUpdateDate: 05/05/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BAILEY
AuthorizedOfficialFirstName: MICHELE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: SENIOR MENTAL HEALTH CLINICIAN
AuthorizedOfficialTelephone: 7087868501
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: LCSW
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251S00000X  Y AgenciesCommunity/Behavioral Health 

No ID Information.


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