MEDICARE: ALLIGN BEHAVIORAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1972312072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIGN BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	3432 W DIVERSEY AVE FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1221
Country	:	US
Telephone Number	:	312-262-6926
Fax Number	:

Provider Business Practice Location Address
First Line	:	3432 W DIVERSEY AVE FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1221
Country	:	US
Telephone Number	:	312-262-6926
Fax Number	:

Authorized Official
Title or Position	:	STAFF
Name	:	NGOZI ADINDU
Credential	:
Telephone Number	:	312-262-6926

Provider Enumeration Date	:	01/03/2025
Last Update Date	:	03/24/2025

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