Provider Demographics
NPI:1194190520
Name:COLLABORATIVE BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:COLLABORATIVE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:TOPEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-922-3253
Mailing Address - Street 1:4711 GOLF RD STE 1200
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1200
Mailing Address - Country:US
Mailing Address - Phone:847-922-3253
Mailing Address - Fax:847-679-8002
Practice Address - Street 1:4711 GOLF RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1224
Practice Address - Country:US
Practice Address - Phone:847-922-3253
Practice Address - Fax:847-679-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008824103TC0700X
IL085001699363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty