Healthcare Provider Details

I. General information

NPI: 1437840964
Provider Name (Legal Business Name): AG BEHAVIORAL HEALTH AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 E HAWTHORN PKWY STE 175
VERNON HILLS IL
60061-1463
US

IV. Provider business mailing address

175 E HAWTHORN PKWY
VERNON HILLS IL
60061-1463
US

V. Phone/Fax

Practice location:
  • Phone: 224-424-0432
  • Fax:
Mailing address:
  • Phone: 224-424-0432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
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: AUDREY GRUNST
Title or Position: CEO
Credential: LCSW
Phone: 414-688-3516