Healthcare Provider Details

I. General information

NPI: 1154725455
Provider Name (Legal Business Name): SHEEHAN BEHAVIORAL CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13625 LARAMIE AVE
CRESTWOOD IL
60445-1566
US

IV. Provider business mailing address

13625 LARAMIE AVE
CRESTWOOD IL
60445-1566
US

V. Phone/Fax

Practice location:
  • Phone: 708-837-3843
  • Fax:
Mailing address:
  • Phone: 708-837-3843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1-12-12059
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1-12-12059
License Number StateIL

VIII. Authorized Official

Name: COLLEEN LYNNE SHEEHAN
Title or Position: BOARD CERTIFIED BEHAVIOR ANALYST
Credential: BCBA
Phone: 708-837-3843