Healthcare Provider Details

I. General information

NPI: 1861070773
Provider Name (Legal Business Name): THE BEHAVIORAL SOLUTIONS GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 FAIRFIELD WAY STE 205
BLOOMINGDALE IL
60108-1500
US

IV. Provider business mailing address

109 FAIRFIELD WAY STE 205
BLOOMINGDALE IL
60108-1500
US

V. Phone/Fax

Practice location:
  • Phone: 815-272-3476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT HENRY VAN SLEE
Title or Position: CO-OWNER/PSYCHOTHERAPIST
Credential: LPC
Phone: 815-272-3476