Healthcare Provider Details

I. General information

NPI: 1346661139
Provider Name (Legal Business Name): INSTITUTE OF NEUROBEHAVIOR SERVICES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14315 108TH AVE SUITE 215
ORLAND PARK IL
60467-5700
US

IV. Provider business mailing address

14315 108TH AVE SUITE 215
ORLAND PARK IL
60467-5700
US

V. Phone/Fax

Practice location:
  • Phone: 708-586-9751
  • Fax:
Mailing address:
  • Phone: 708-586-9751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036126035
License Number StateIL

VIII. Authorized Official

Name: DR. EVALDAS RADZEVICIUS
Title or Position: DIRECTOR OF OPERATIONS
Credential: MD
Phone: 312-860-7017