Healthcare Provider Details

I. General information

NPI: 1477200079
Provider Name (Legal Business Name): GLOBAL EXECUTIVE COUNCIL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 03/04/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2697 GRAND AVE
WAUKEGAN IL
60085-2410
US

IV. Provider business mailing address

5810 N LINCOLN AVE
CHICAGO IL
60659-4602
US

V. Phone/Fax

Practice location:
  • Phone: 224-656-5557
  • Fax:
Mailing address:
  • Phone: 773-766-0767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: NAZNEEN BEGUM
Title or Position: CEO
Credential:
Phone: 773-766-0767