Healthcare Provider Details

I. General information

NPI: 1255804167
Provider Name (Legal Business Name): COREY & CYNTHIA F. DABNEY BEHAVIORAL HEALTH HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 W 69TH STREET LOWER LEVEL
CHICAGO IL
60621-1709
US

IV. Provider business mailing address

845 W 69TH STREET LOWER LEVEL
CHICAGO IL
60621-1709
US

V. Phone/Fax

Practice location:
  • Phone: 917-618-4042
  • Fax:
Mailing address:
  • Phone: 917-618-4042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: PROF. COREY DABNEY
Title or Position: CEO AND CHAIRMAN
Credential: QMHP, MBA, M.S.
Phone: 917-618-4042