Healthcare Provider Details

I. General information

NPI: 1699685081
Provider Name (Legal Business Name): WILLOWCREST BEHAVIORAL HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 W ARMY TRAIL RD STE 100
ADDISON IL
60101-1478
US

IV. Provider business mailing address

800 ENTERPRISE DR STE 214
OAK BROOK IL
60523-4218
US

V. Phone/Fax

Practice location:
  • Phone: 312-600-5061
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LEWIS
Title or Position: OWNER
Credential:
Phone: 312-600-5061