MEDICARE: BODH CENTER FOR WELLNESS

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	103G00000X	Clinical Neuropsychologist
2	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1255900411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODH CENTER FOR WELLNESS

Provider Business Mailing Address
First Line	:	2063 OLIVE HILL DR
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-4644
Country	:	US
Telephone Number	:	630-828-6867
Fax Number	:	630-293-5814

Provider Business Practice Location Address
First Line	:	2150 E LAKE COOK RD FL 9
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1862
Country	:	US
Telephone Number	:	630-828-6867
Fax Number	:	630-293-5814

Authorized Official
Title or Position	:	FOUNDER
Name	:	DR. DIVYA JAIN
Credential	:	PSY.D.
Telephone Number	:	630-828-6867

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	01/24/2025

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Directions to “BODH CENTER FOR WELLNESS ” Practice Location

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