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General NPI Number Information
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NPI Number | 1992051130
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Entity Type | Organization
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Legal Business Name | NEUROBEHAVIORAL GROUP PC
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 11/01/2013
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Provider Practice Location Address
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Address Line | 1755 PARK ST #200
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City | NAPERVILLE
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State | IL
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Zip | 60563-4861
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Country | US
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Telephone | 630-449-4270
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Fax | 630-820-2358
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Provider Business Mailing Address
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Address Line | 1755 PARK ST #200
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City | NAPERVILLE
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State | IL
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Zip | 60563-4861
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Country | US
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Telephone | 630-449-4270
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Fax | 630-820-2358
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE R MYERS
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Credential | PSY.D.
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Telephone | 773-972-4248
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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 | 071007744
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 071007744
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License Number State | IL
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