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General NPI Number Information
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NPI Number | 1730201971
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Entity Type | Organization
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Legal Business Name | CENTER FOR BEHAVIORAL HEALTH & WELLNESS, LLC
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1440 RENAISSANCE DR SUITE 200
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City | PARK RIDGE
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State | IL
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Zip | 60068-1356
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Country | US
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Telephone | 847-296-3484
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Fax |
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Provider Business Mailing Address
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Address Line | 549 IVORY LN
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City | BARTLETT
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State | IL
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Zip | 60103-1230
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Country | US
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Telephone | 630-540-9495
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. RITU DEVENDRA TRIVEDI-PUROHIT
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Credential | PSYD.
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Telephone | 847-296-3484
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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 | IL
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