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General NPI Number Information
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NPI Number | 1811267198
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Entity Type | Organization
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Legal Business Name | BELGRADE BEHAVIOR CONSULTING, LLC
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Dates
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Enumeration Date | 01/04/2012
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 4801 W PETERSON AVE SUITE 403
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City | CHICAGO
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State | IL
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Zip | 60646-5713
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Country | US
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Telephone | 773-407-1121
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Fax | 773-588-3374
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Provider Business Mailing Address
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Address Line | 4801 W PETERSON AVE SUITE 403
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City | CHICAGO
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State | IL
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Zip | 60646-5713
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Country | US
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Telephone | 773-407-1121
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Fax | 773-588-3374
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Authorized Official
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Title or Position | BEHAVIOR ANALYST/OWNER
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Name | ALICE BELGRADE-MOSS
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Credential | L.C.P.C., B.C.B.A.
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Telephone | 773-407-1121
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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 | 1-09-5011
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180-002740
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License Number State | IL
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