Healthcare Provider Details

I. General information

NPI: 1831182534
Provider Name (Legal Business Name): LYNDA MARIE BEHRENDT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 REMINGTON RD SUITE T
SCHAUMBURG IL
60173-4814
US

IV. Provider business mailing address

PO BOX 143
ROUND LAKE BEACH IL
60073-4130
US

V. Phone/Fax

Practice location:
  • Phone: 847-254-1000
  • Fax: 847-543-1675
Mailing address:
  • Phone: 847-254-1000
  • Fax: 847-543-1675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number071005896
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071005896
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number071-005896
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: