MEDICARE: BEHAVORIAL HEALTH ASSOCIATES LTD

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	103TA0700X	Adult Development & Aging Psychologist	071-005194	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14-1854431	OTHER	IL	FEDERAL TAX ID

General Provider Information

NPI Number	:	1215153853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVORIAL HEALTH ASSOCIATES LTD

Provider Business Mailing Address
First Line	:	PO BOX 2257
Second Line	:
City	:	CHESTERTON
State	:	IN
Zip	:	46304-0357
Country	:	US
Telephone Number	:	219-926-8320
Fax Number	:	219-926-3524

Provider Business Practice Location Address
First Line	:	8 S MICHIGAN AVE
Second Line	:	STE 1203
City	:	CHICAGO
State	:	IL
Zip	:	60603-3357
Country	:	US
Telephone Number	:	773-710-3493
Fax Number	:	312-781-9594

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. NEIL R. BOCKIAN
Credential	:	PH.D
Telephone Number	:	773-710-3493

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	06/21/2018

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