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General NPI Number Information
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NPI Number | 1427496876
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Entity Type | Organization
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Legal Business Name | PROVEN BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 06/07/2013
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Last Update Date | 10/18/2019
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Provider Practice Location Address
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Address Line | 500 N DEARBORN SUITE 303
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City | CHICAGO
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State | IL
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Zip | 60654
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Country | US
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Telephone | 312-919-4404
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Fax | 312-585-5424
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Provider Business Mailing Address
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Address Line | 500 N DEARBORN SUITE 303
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City | CHICAGO
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State | IL
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Zip | 60654
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Country | US
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Telephone | 312-919-4404
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Fax | 312-585-5424
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Authorized Official
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Title or Position | PRESIDENT/LICENSED CLINICAL PSYCHOL
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Name | MARGARET MELANIPHY
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Credential | PSYD
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Telephone | 312-919-4404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071008465
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License Number State | IL
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