Provider Demographics
NPI:1275661274
Name:V & R BEHAVIORAL HEALTH SERVICES LTD.
Entity Type:Organization
Organization Name:V & R BEHAVIORAL HEALTH SERVICES LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:VASELAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-226-0010
Mailing Address - Street 1:500 RAVINIA PL
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3758
Mailing Address - Country:US
Mailing Address - Phone:708-460-9833
Mailing Address - Fax:708-460-1117
Practice Address - Street 1:700 RAVINIA PL
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3700
Practice Address - Country:US
Practice Address - Phone:708-226-0010
Practice Address - Fax:708-226-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2013-04-30
Deactivation Date:2008-08-08
Deactivation Code:
Reactivation Date:2008-09-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001622805OtherBLUECROSS BLUESHIELD
ILP16089Medicare UPIN
ILP14762Medicare UPIN
ILP97848Medicare UPIN
IL202605Medicare ID - Type Unspecified
IL599100Medicare ID - Type Unspecified