Healthcare Provider Details

I. General information

NPI: 1972873768
Provider Name (Legal Business Name): CENTER FOR BEHAVIOR INTERVENTION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19056 HENRY DR
MOKENA IL
60448-9302
US

IV. Provider business mailing address

1272 BOND ST STE 100
NAPERVILLE IL
60563-3084
US

V. Phone/Fax

Practice location:
  • Phone: 708-995-5751
  • Fax:
Mailing address:
  • Phone: 855-444-5664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1 11 8054
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1 07 3922
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JUSTIN STUMP
Title or Position: CFO
Credential:
Phone: 855-444-5664