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General NPI Number Information
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NPI Number | 1114319043
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Entity Type | Organization
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Legal Business Name | LIFELINE BEHAVIORAL HEALTHCARE LTD.
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 18301 DISTINCTIVE DR
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City | ORLAND PARK
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State | IL
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Zip | 60467-9461
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Country | US
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Telephone | 708-928-5700
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Fax | 708-570-1617
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Provider Business Mailing Address
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Address Line | 18301 DISTINCTIVE DR
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City | ORLAND PARK
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State | IL
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Zip | 60467-9461
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Country | US
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Telephone | 708-928-5700
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Fax | 708-570-1617
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SHERYL L ANKROM
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Credential | LCPC
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Telephone | 708-606-1334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180007337
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License Number State | IL
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