Healthcare Provider Details

I. General information

NPI: 1801477799
Provider Name (Legal Business Name): INDIVIDUAL ADVOCACY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PHELPS AVE
ROMEOVILLE IL
60446-1335
US

IV. Provider business mailing address

1289 WINDHAM PKWY
ROMEOVILLE IL
60446-1763
US

V. Phone/Fax

Practice location:
  • Phone: 815-372-8950
  • Fax: 815-372-8960
Mailing address:
  • Phone: 630-759-0201
  • Fax:

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: DR. DAVID HEBER BROOKS
Title or Position: COO
Credential: PHD
Phone: 630-759-0201