Provider Demographics
NPI:1457656472
Name:CLINICAL BEHAVIOR CONSULTANTS
Entity Type:Organization
Organization Name:CLINICAL BEHAVIOR CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELORIS
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:630-424-9365
Mailing Address - Street 1:55 W 22ND ST
Mailing Address - Street 2:#305
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4854
Mailing Address - Country:US
Mailing Address - Phone:639-424-9365
Mailing Address - Fax:630-424-9368
Practice Address - Street 1:55 W 22ND ST
Practice Address - Street 2:#305
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4854
Practice Address - Country:US
Practice Address - Phone:639-424-9365
Practice Address - Fax:630-424-9368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-23
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490043111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty