Healthcare Provider Details

I. General information

NPI: 1194245845
Provider Name (Legal Business Name): OBJECTIVES BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 NORTH AVE
OAK PARK IL
60302-1005
US

IV. Provider business mailing address

1674 W MAYPOLE AVE
CHICAGO IL
60612-2615
US

V. Phone/Fax

Practice location:
  • Phone: 312-622-3526
  • Fax:
Mailing address:
  • Phone: 312-622-3526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149011450
License Number StateIL

VIII. Authorized Official

Name: VALORIE JAMES
Title or Position: OWNER
Credential: LCSW
Phone: 312-622-3526