Provider Demographics
NPI:1114680055
Name:ENVISION UNLIMITED
Entity Type:Organization
Organization Name:ENVISION UNLIMITED
Other - Org Name:ENVISION UNLIMITED ABA THERAPY PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMEERA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JACKSON-REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:872-270-2349
Mailing Address - Street 1:8 S MICHIGAN AVE STE 1700
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3353
Mailing Address - Country:US
Mailing Address - Phone:872-895-7942
Mailing Address - Fax:800-391-8460
Practice Address - Street 1:8 S MICHIGAN AVE STE 1700
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3353
Practice Address - Country:US
Practice Address - Phone:872-895-7942
Practice Address - Fax:800-391-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty