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General NPI Number Information
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NPI Number | 1881414746
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Entity Type | Organization
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Legal Business Name | AY BEHAVIORAL HEALTH AND HOLISTIC CARE INC
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 217 CHRISTINE WAY
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City | BOLINGBROOK
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State | IL
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Zip | 60440-6138
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Country | US
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Telephone | 773-540-6231
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Fax |
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Provider Business Mailing Address
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Address Line | 217 CHRISTINE WAY
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City | BOLINGBROOK
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State | IL
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Zip | 60440-6138
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Country | US
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Telephone | 773-540-6231
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EVELYN UKPOLO
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Credential |
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Telephone | 773-540-6231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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