Healthcare Provider Details

I. General information

NPI: 1568148344
Provider Name (Legal Business Name): FORESIGHT BEHAVIORAL HEALTH CLINIC OF HUMBOLDT PARK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 09/02/2025
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 W NORTH AVE STE 201
CHICAGO IL
60622-1488
US

IV. Provider business mailing address

303 E WACKER DR STE 2110
CHICAGO IL
60601-5312
US

V. Phone/Fax

Practice location:
  • Phone: 312-414-1341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH HYLAK-REINHOLTZ
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 312-414-1342