Healthcare Provider Details

I. General information

NPI: 1588069306
Provider Name (Legal Business Name): ADVANCED PSYCHIATRY OF ELGIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 POINT BLVD SUITE 200
ELGIN IL
60123-9215
US

IV. Provider business mailing address

2130 POINT BLVD SUITE 200
ELGIN IL
60123-9215
US

V. Phone/Fax

Practice location:
  • Phone: 847-783-0307
  • Fax:
Mailing address:
  • Phone: 847-783-0307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number036111811
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149004898
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149016112
License Number StateIL

VIII. Authorized Official

Name: ALEATHA HOWEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 847-783-0307