Provider Demographics
NPI:1518318666
Name:CHICAGO AREA BEHAVIORAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:CHICAGO AREA BEHAVIORAL HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTUS
Authorized Official - Middle Name:
Authorized Official - Last Name:EDEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-412-7420
Mailing Address - Street 1:150 W SAINT CHARLES RD
Mailing Address - Street 2:SUITE 123
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2288
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5658 S KOLIN AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4839
Practice Address - Country:US
Practice Address - Phone:708-876-7525
Practice Address - Fax:708-544-0630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490150781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty