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General NPI Number Information
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NPI Number | 1235398546
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF BEHAVIORAL SCIENCES
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 1645 W JACKSON BLVD SUITE 400
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City | CHICAGO
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State | IL
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Zip | 60612-3276
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Country | US
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Telephone | 312-942-5932
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Fax |
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Provider Business Mailing Address
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Address Line | 1645 W JACKSON BLVD SUITE 400
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City | CHICAGO
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State | IL
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Zip | 60612-3276
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Country | US
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Telephone | 312-942-5932
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | BRIAN T SMITH
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Credential |
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Telephone | 312-942-6909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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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 | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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