Healthcare Provider Details

I. General information

NPI: 1487995361
Provider Name (Legal Business Name): PROACTIVE BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2013
Last Update Date: 03/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N MAIN ST
ALGONQUIN IL
60102-2448
US

IV. Provider business mailing address

26112 W INDIAN TRAIL RD
BARRINGTON IL
60010-1344
US

V. Phone/Fax

Practice location:
  • Phone: 224-678-9033
  • Fax: 224-678-9493
Mailing address:
  • Phone: 847-776-4500
  • Fax: 847-776-4724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number30204
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178008534
License Number StateIL

VIII. Authorized Official

Name: DR. TODD RUSSELL LENDVAY
Title or Position: OWNER/PSYCHOLOGIST
Credential: PSYD
Phone: 847-776-4500