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General NPI Number Information
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NPI Number | 1598284416
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Entity Type | Organization
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Legal Business Name | OPUS BEHAVIORAL HEALTH, INC.
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 3727 N KEELER AVE
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City | CHICAGO
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State | IL
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Zip | 60641-3050
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Country | US
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Telephone | 773-504-2157
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Fax |
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Provider Business Mailing Address
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Address Line | 3727 N. KEELER AVE. 1F
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City | CHICAGO
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State | IL
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Zip | 60641
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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 | OWNER
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Name | DR. WENDY GOETZ
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Credential |
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Telephone | 773-504-2157
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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 |
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License Number State |
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