Provider Demographics
NPI:1225525918
Name:COMPASS BEHAVIORAL HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:COMPASS BEHAVIORAL HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PELLICANO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-453-5188
Mailing Address - Street 1:600 S WASHINGTON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6666
Mailing Address - Country:US
Mailing Address - Phone:630-453-5188
Mailing Address - Fax:
Practice Address - Street 1:600 S WASHINGTON ST STE 202
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540
Practice Address - Country:US
Practice Address - Phone:630-453-5188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006509101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1922396019Medicaid