Provider Demographics
NPI:1043437049
Name:PROACTIVE BEHAVIORAL SERVICES, INC.
Entity Type:Organization
Organization Name:PROACTIVE BEHAVIORAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:R
Authorized Official - Last Name:LENDVAY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-778-4500
Mailing Address - Street 1:1644 W. COLONIAL PKWY.
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:IL
Mailing Address - Zip Code:60067-1207
Mailing Address - Country:US
Mailing Address - Phone:847-776-4500
Mailing Address - Fax:847-776-4724
Practice Address - Street 1:1644 W. COLONIAL PKWY.
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60067-1207
Practice Address - Country:US
Practice Address - Phone:847-776-4500
Practice Address - Fax:847-776-4724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071--007171103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
04932629OtherBLUE CROSS
216635Medicare UPIN