=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376343327
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRIBE WORKS BEHAVIORAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2025
-----------------------------------------------------
Last Update Date | 04/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 404 WINNEBAGO ST
-----------------------------------------------------
City | PARK FOREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60466-1320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-269-1927
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 404 WINNEBAGO ST
-----------------------------------------------------
City | PARK FOREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60466-1320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LCSW
-----------------------------------------------------
Name | SAMARA LYNCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-269-1927
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------