Healthcare Provider Details

I. General information

NPI: 1891516126
Provider Name (Legal Business Name): STEP BY STEP BEHAVIOR THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2024
Last Update Date: 10/19/2024
Certification Date: 10/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14562 SHETLAND DR
HOMER GLEN IL
60491-8806
US

IV. Provider business mailing address

14562 SHETLAND DR
HOMER GLEN IL
60491-8806
US

V. Phone/Fax

Practice location:
  • Phone: 708-551-6834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SUHA MOHAMMAD
Title or Position: OWNER
Credential: BCBA
Phone: 708-551-6834