MEDICARE: NORTHWEST BEHAVIORAL HEALTH SERVICES, PC

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	103TC0700X	Clinical Psychologist	071-006787	IL

General Provider Information

NPI Number	:	1770609315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST BEHAVIORAL HEALTH SERVICES, PC

Provider Business Mailing Address
First Line	:	415 W GOLF RD STE 16
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3923
Country	:	US
Telephone Number	:	847-577-0904
Fax Number	:	847-577-1558

Provider Business Practice Location Address
First Line	:	415 W GOLF RD STE 16
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3923
Country	:	US
Telephone Number	:	847-577-0904
Fax Number	:	847-577-1558

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTOPHER D WATSON
Credential	:	PSY.D.
Telephone Number	:	847-577-0904

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	12/21/2018

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