Healthcare Provider Details

I. General information

NPI: 1386352193
Provider Name (Legal Business Name): PRESENCE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 N. LASALLE ST. #400
CHICAGO IL
60602-1086
US

IV. Provider business mailing address

1820 S 25TH AVE
BROADVIEW IL
60155-3960
US

V. Phone/Fax

Practice location:
  • Phone: 847-493-3722
  • Fax:
Mailing address:
  • Phone: 708-786-2030
  • Fax: 708-681-1289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERRI HOWE
Title or Position: UTILIZATION COORDINATIOR
Credential: BSW
Phone: 708-786-2030