Healthcare Provider Details

I. General information

NPI: 1740041110
Provider Name (Legal Business Name): SKYLARK BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 06/04/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CENTRAL AVE STE 250
NORTHFIELD IL
60093-3024
US

IV. Provider business mailing address

400 CENTRAL AVE STE 250
NORTHFIELD IL
60093-3024
US

V. Phone/Fax

Practice location:
  • Phone: 847-629-4696
  • Fax: 847-629-4696
Mailing address:
  • Phone: 847-629-4696
  • Fax: 847-629-4696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER MORRILL
Title or Position: PRESIDENT
Credential: MD
Phone: 847-629-4696