Healthcare Provider Details

I. General information

NPI: 1649248113
Provider Name (Legal Business Name): BEHAVIORAL HEALTH ADVANTAGES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 N. VILLA LAKE DR. SUITE D
PEORIA IL
61614-8235
US

IV. Provider business mailing address

7210 N. VILLA LAKE DR. SUITE D
PEORIA IL
61614-8235
US

V. Phone/Fax

Practice location:
  • Phone: 309-589-1011
  • Fax: 309-589-1019
Mailing address:
  • Phone: 309-589-1011
  • Fax: 309-589-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MS. NANCY AFFOLTER
Title or Position: V.P., COO
Credential:
Phone: 309-589-1011