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General NPI Number Information
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NPI Number | 1396121976
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Entity Type | Organization
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Legal Business Name | STUBNAR BEHAVIORAL SERVICES CORPORATION
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Dates
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Enumeration Date | 08/05/2015
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Last Update Date | 08/05/2015
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Provider Practice Location Address
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Address Line | 451 W WRIGHTWOOD AVE #913
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City | CHICAGO
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State | IL
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Zip | 60614-1882
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Country | US
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Telephone | 618-201-1146
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Fax |
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Provider Business Mailing Address
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Address Line | 451 W WRIGHTWOOD AVE #913
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City | CHICAGO
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State | IL
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Zip | 60614-1882
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Country | US
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Telephone | 618-201-1146
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOLLY M STUBNAR
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Credential | BCBA
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Telephone | 618-201-1146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-07-3682
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License Number State | IL
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