Healthcare Provider Details

I. General information

NPI: 1427292994
Provider Name (Legal Business Name): FOX VALLEY BEHAVIORAL HEALTH, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 S RANDALL RD SUITE C 187
ST CHARLES IL
60174-1554
US

IV. Provider business mailing address

902 S RANDALL RD SUITE C 187
ST CHARLES IL
60174-1554
US

V. Phone/Fax

Practice location:
  • Phone: 630-356-3621
  • Fax: 630-377-3705
Mailing address:
  • Phone: 630-356-3621
  • Fax: 630-377-3705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036098990
License Number StateIL

VIII. Authorized Official

Name: DR. JABEEN HUSSAIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 630-356-3621