MEDICARE: INNERGY BEHAVIORAL HEALTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1134956170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNERGY BEHAVIORAL HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	875 NORTH MICHIGAN AVE, 31ST FLOOR STE 3141
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611
Country	:	US
Telephone Number	:	832-754-6495
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 NORTH MICHIGAN AVE, 31ST FLOOR STE 3141
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-1771
Country	:	US
Telephone Number	:	832-754-6495
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MISS TRAVIS CLAYDE LOUALLEN
Credential	:	RRT
Telephone Number	:	832-754-6495

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	09/16/2025

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