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General NPI Number Information
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NPI Number | 1518318666
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Entity Type | Organization
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Legal Business Name | CHICAGO AREA BEHAVIORAL HEALTH SERVICES INC
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Dates
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Enumeration Date | 06/29/2016
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 5658 S KOLIN AVE UNIT 2
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City | CHICAGO
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State | IL
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Zip | 60629-4839
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Country | US
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Telephone | 708-876-7525
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Fax | 708-544-0630
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Provider Business Mailing Address
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Address Line | 150 W SAINT CHARLES RD SUITE 123
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City | LOMBARD
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State | IL
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Zip | 60148-2288
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | AUGUSTUS EDEH
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Credential |
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Telephone | 773-412-7420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149015078
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License Number State | IL
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