Healthcare Provider Details

I. General information

NPI: 1821713678
Provider Name (Legal Business Name): S & T BEHAVIORAL HEALTH AND MEDICAL CONSULTANTS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E PHOENIX CENTER DR
PHOENIX IL
60426-1700
US

IV. Provider business mailing address

650 E PHOENIX CENTER DR
PHOENIX IL
60426-1700
US

V. Phone/Fax

Practice location:
  • Phone: 630-776-4694
  • Fax: 630-423-3277
Mailing address:
  • Phone: 630-776-4694
  • Fax: 630-423-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES LEVY
Title or Position: PRESIDENT
Credential:
Phone: 630-776-4694