Healthcare Provider Details

I. General information

NPI: 1326212770
Provider Name (Legal Business Name): LIFETIME BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E WASHINGTON ST SUITE A
WEST CHICAGO IL
60185-2228
US

IV. Provider business mailing address

550 E WASHINGTON ST SUITE A
WEST CHICAGO IL
60185-2228
US

V. Phone/Fax

Practice location:
  • Phone: 630-525-0025
  • Fax:
Mailing address:
  • Phone: 630-525-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHERINE A WALKER
Title or Position: PRESIDENT, OWNER
Credential: LCPC, NCC
Phone: 630-525-0025