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General NPI Number Information
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NPI Number | 1194190520
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 4711 GOLF RD SUITE 1200
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City | SKOKIE
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State | IL
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Zip | 60076-1224
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Country | US
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Telephone | 847-922-3253
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Fax | 847-679-8002
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Provider Business Mailing Address
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Address Line | 4711 GOLF RD STE 1200
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City | SKOKIE
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State | IL
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Zip | 60076-1200
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Country | US
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Telephone | 847-922-3253
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Fax | 847-679-8002
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MICHAEL EDWARD TOPEL
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Credential | PSYD
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Telephone | 847-922-3253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085001699
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.008824
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License Number State | IL
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