Healthcare Provider Details

I. General information

NPI: 1366364358
Provider Name (Legal Business Name): BIRDSONG BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 DAVIS ST STE 301
EVANSTON IL
60201-4480
US

IV. Provider business mailing address

630 DAVIS ST STE 301
EVANSTON IL
60201-4480
US

V. Phone/Fax

Practice location:
  • Phone: 224-470-1499
  • Fax:
Mailing address:
  • Phone: 224-470-1499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: LARKIN RICHARDS
Title or Position: PMHNP
Credential: APRN
Phone: 773-678-2846