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General NPI Number Information
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NPI Number | 1821537358
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Entity Type | Organization
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Legal Business Name | THE ANXIETY TREATMENT CENTER - WESTERN SUBURBS, LLC
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 07/21/2018
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Provider Practice Location Address
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Address Line | 1100 JORIE BLVD 227
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City | OAK BROOK
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State | IL
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Zip | 60523
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Country | US
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Telephone | 630-522-3124
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 JORIE BLVD STE 132
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City | OAK BROOK
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State | IL
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Zip | 60523-4402
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Country | US
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Telephone | 630-522-3124
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Fax |
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Authorized Official
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Title or Position | OWNER, DIRECTOR
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Name | BENJAMIN G HARRIS
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Credential |
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Telephone | 630-522-3124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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