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General NPI Number Information
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NPI Number | 1194900050
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Entity Type | Organization
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Legal Business Name | LAKE BARRINGTON PROFESSIONAL SERVICES
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 5067 SHORELINE RD
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City | LAKE BARRINGTON
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State | IL
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Zip | 60010-1700
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Country | US
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Telephone | 847-842-0012
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Fax | 847-842-0013
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Provider Business Mailing Address
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Address Line | 5067 SHORELINE RD
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City | LAKE BARRINGTON
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State | IL
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Zip | 60010-1700
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Country | US
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Telephone | 847-842-0012
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Fax | 847-842-0013
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. JULIE T CONSOLO
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Credential |
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Telephone | 847-842-0012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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