Healthcare Provider Details

I. General information

NPI: 1881531093
Provider Name (Legal Business Name): BYRON DOUGLAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 LEE ST STE 920H
DES PLAINES IL
60016-4557
US

IV. Provider business mailing address

9114 WAUKEGAN RD UNIT 945
MORTON GROVE IL
60053-3837
US

V. Phone/Fax

Practice location:
  • Phone: 847-322-6695
  • Fax: 224-938-9046
Mailing address:
  • Phone: 847-322-6695
  • Fax: 224-938-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN BALL
Title or Position: CLINICIAN
Credential: LCPC,CADC,CEAP
Phone: 847-322-6695