Healthcare Provider Details

I. General information

NPI: 1306007778
Provider Name (Legal Business Name): PRIZM BEHAVIORAL SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MARTIN AVE
NAPERVILLE IL
60540-6536
US

IV. Provider business mailing address

PO BOX 2800
NAPERVILLE IL
60567-2800
US

V. Phone/Fax

Practice location:
  • Phone: 630-848-1200
  • Fax: 630-848-1208
Mailing address:
  • Phone: 630-848-1200
  • Fax: 630-848-1208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number036114959
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number036114959
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number036114959
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number036114959
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number036114959
License Number StateIL
# 6
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number036114959
License Number StateIL

VIII. Authorized Official

Name: MS. ASMAT Z JAFRY
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 630-848-1200