Healthcare Provider Details

I. General information

NPI: 1548990393
Provider Name (Legal Business Name): NOCD FLORIDA BEHAVIORAL HEALTH P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N MICHIGAN AVE STE 1430
CHICAGO IL
60601-7653
US

IV. Provider business mailing address

225 N MICHIGAN AVE STE 1430
CHICAGO IL
60601-7653
US

V. Phone/Fax

Practice location:
  • Phone: 312-766-6780
  • Fax: 312-261-5080
Mailing address:
  • Phone:
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LARRY TRUSKY
Title or Position: COO
Credential:
Phone: 847-436-3265