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General NPI Number Information
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NPI Number | 1063225068
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Entity Type | Organization
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Legal Business Name | NORTH SHORE BEHAVIOR CORP
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 1525 LAKE COOK RD APT 155
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City | DEERFIELD
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State | IL
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Zip | 60015-5296
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Country | US
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Telephone | 773-502-3361
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 LAKE COOK RD APT 155
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City | DEERFIELD
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State | IL
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Zip | 60015-5296
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Country | US
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Telephone | 773-502-3361
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JAYME CROOKS
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Credential | MA, BCBA
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Telephone | 773-502-3361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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