Healthcare Provider Details

I. General information

NPI: 1437667805
Provider Name (Legal Business Name): PARTNERSHIPS IN BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9933 S WESTERN AVE STE 203
CHICAGO IL
60643-1810
US

IV. Provider business mailing address

9933 S WESTERN AVE STE 203
CHICAGO IL
60643-1810
US

V. Phone/Fax

Practice location:
  • Phone: 312-730-3966
  • Fax: 312-803-1635
Mailing address:
  • Phone: 312-730-3966
  • Fax: 312-803-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071009102
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149008520
License Number StateIL

VIII. Authorized Official

Name: DR. NICOLE THOMAS
Title or Position: OPERATIONS DIRECTOR
Credential: ED.D.
Phone: 312-730-3966