Healthcare Provider Details

I. General information

NPI: 1467633966
Provider Name (Legal Business Name): CIRCLES BEHAVIOR CONSULTATION SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 E EMPIRE SUITE G
BLOOMINGTON IL
61704-3706
US

IV. Provider business mailing address

2203 E EMPIRE ST SUITE G
BLOOMINGTON IL
61704-3706
US

V. Phone/Fax

Practice location:
  • Phone: 309-662-5050
  • Fax: 630-303-9704
Mailing address:
  • Phone: 309-662-5050
  • Fax: 630-303-9704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1073716
License Number StateIL

VIII. Authorized Official

Name: MRS. KIMBERLY ANN WILLIAMSON
Title or Position: DIRECTOR
Credential: BCBA
Phone: 309-662-5050