Healthcare Provider Details

I. General information

NPI: 1316083231
Provider Name (Legal Business Name): BEHAVIORAL HEALTH CARE ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 E SCHAUMBURG RD SUITE 260
SCHAUMBURG IL
60194-3658
US

IV. Provider business mailing address

1375 E SCHAUMBURG RD SUITE 260
SCHAUMBURG IL
60194-3658
US

V. Phone/Fax

Practice location:
  • Phone: 847-895-4540
  • Fax: 847-895-4544
Mailing address:
  • Phone: 847-895-4540
  • Fax: 847-895-4544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number036079918
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BLAISE JOSEPH WOLFRUM
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 847-895-4540