Healthcare Provider Details

I. General information

NPI: 1215153853
Provider Name (Legal Business Name): BEHAVORIAL HEALTH ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 S MICHIGAN AVE STE 1203
CHICAGO IL
60603-3357
US

IV. Provider business mailing address

PO BOX 2257
CHESTERTON IN
46304-0357
US

V. Phone/Fax

Practice location:
  • Phone: 773-710-3493
  • Fax: 312-781-9594
Mailing address:
  • Phone: 219-926-8320
  • Fax: 219-926-3524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number071-005194
License Number StateIL

VIII. Authorized Official

Name: DR. NEIL R. BOCKIAN
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D
Phone: 773-710-3493