Provider Demographics
NPI:1194201335
Name:BESS PRACTICE LLC
Entity Type:Organization
Organization Name:BESS PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:BOW
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:309-696-5071
Mailing Address - Street 1:712 E WAR MEMORIAL DR STE D
Mailing Address - Street 2:
Mailing Address - City:PEORIA HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:61616-7548
Mailing Address - Country:US
Mailing Address - Phone:309-696-5071
Mailing Address - Fax:309-403-0346
Practice Address - Street 1:712 E WAR MEMORIAL DR STE D
Practice Address - Street 2:
Practice Address - City:PEORIA HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:61616-7548
Practice Address - Country:US
Practice Address - Phone:309-696-5071
Practice Address - Fax:309-403-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010040101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty