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General NPI Number Information
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NPI Number | 1619360211
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Entity Type | Organization
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Legal Business Name | ACCENTUATED BEHAVIORAL CONCEPTS AND INTEGRATED SOLUTIONS (ABC IS) LLC
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Dates
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Enumeration Date | 03/06/2015
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 3353 W WILSON AVE APT 3R
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City | CHICAGO
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State | IL
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Zip | 60625-5337
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Country | US
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Telephone | 773-998-1353
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Fax |
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Provider Business Mailing Address
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Address Line | 3353 W WILSON AVE APT 3R
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City | CHICAGO
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State | IL
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Zip | 60625-5337
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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 | PRACTICE MANAGER
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Name | ALINA GRITSINA
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Credential |
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Telephone | 773-998-1353
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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 |
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License Number State |
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