Healthcare Provider Details

I. General information

NPI: 1003106139
Provider Name (Legal Business Name): DOWNERS GROVE BEHAVIORAL HEALTH ASSOCIATES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CURTISS ST
DOWNERS GROVE IL
60515-4694
US

IV. Provider business mailing address

1105 CURTISS ST
DOWNERS GROVE IL
60515-4694
US

V. Phone/Fax

Practice location:
  • Phone: 630-968-9817
  • Fax:
Mailing address:
  • Phone: 630-968-9817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORI ANN ANDREWS
Title or Position: MEMBER
Credential:
Phone: 630-968-9817