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General NPI Number Information
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NPI Number | 1255804167
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Entity Type | Organization
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Legal Business Name | COREY & CYNTHIA F. DABNEY BEHAVIORAL HEALTH HOSPITAL
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Dates
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Enumeration Date | 01/03/2019
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Last Update Date | 10/23/2019
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Provider Practice Location Address
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Address Line | 845 W 69TH STREET LOWER LEVEL
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City | CHICAGO
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State | IL
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Zip | 60621-1709
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Country | US
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Telephone | 917-618-4042
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Fax |
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Provider Business Mailing Address
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Address Line | 845 W 69TH STREET LOWER LEVEL
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City | CHICAGO
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State | IL
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Zip | 60621-1709
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Country | US
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Telephone | 917-618-4042
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Fax |
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Authorized Official
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Title or Position | CEO AND CHAIRMAN
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Name | PROF. COREY DABNEY
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Credential | QMHP, MBA, M.S.
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Telephone | 917-618-4042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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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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Taxonomy #5
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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