Provider Demographics
NPI:1164882650
Name:INSIGHT:EATING DISORDERS, WEIGHT MANAGEMENT & PSYCHOLOGICAL CENTERS
Entity Type:Organization
Organization Name:INSIGHT:EATING DISORDERS, WEIGHT MANAGEMENT & PSYCHOLOGICAL CENTERS
Other - Org Name:EATING RECOVERY CENTER OF ILLINOIS DBA INSIGHT BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTING & CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-540-9955
Mailing Address - Street 1:PO BOX 561478
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256
Mailing Address - Country:US
Mailing Address - Phone:877-825-8584
Mailing Address - Fax:
Practice Address - Street 1:4210 LAKE COOK RD.
Practice Address - Street 2:FLOOR 2ND AND 3RD
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062
Practice Address - Country:US
Practice Address - Phone:877-825-8584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty