Healthcare Provider Details

I. General information

NPI: 1518098771
Provider Name (Legal Business Name): COMMUNITY YOUTH NETWORK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18640 W IL ROUTE 120
GRAYSLAKE IL
60030
US

IV. Provider business mailing address

18640 W IL ROUTE 120
GRAYSLAKE IL
60030
US

V. Phone/Fax

Practice location:
  • Phone: 847-548-6000
  • Fax: 847-548-6040
Mailing address:
  • Phone: 847-548-6000
  • Fax: 847-548-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number149001053
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number5138-995-6
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN SEABERT
Title or Position: BILLING/CREDENTIALING SPECIALIST
Credential: RHIT
Phone: 847-548-6000