MEDICARE: MILLENNIUM BEHAVIOR HEALTH SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	174H00000X	Health Educator
3	251S00000X	Community/Behavioral Health Agency
4	261QC1500X	Community Health Clinic/Center
5	261QH0100X	Health Service Clinic/Center
6	261QM2800X	Methadone Clinic
7	363LF0000X	Family Nurse Practitioner
8	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1780450643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM BEHAVIOR HEALTH SERVICES

Provider Business Mailing Address
First Line	:	2441 W 79TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-1734
Country	:	US
Telephone Number	:	773-306-2975
Fax Number	:	872-267-7166

Provider Business Practice Location Address
First Line	:	2441 W 79TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-1734
Country	:	US
Telephone Number	:	773-306-2975
Fax Number	:	872-267-7166

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. BRENDA JOYCE GOLDEN
Credential	:
Telephone Number	:	773-306-2975

Provider Enumeration Date	:	11/30/2023
Last Update Date	:	04/17/2025

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