Provider Demographics
NPI:1518585942
Name:TABS BEHAVIORAL HEALTH INC
Entity Type:Organization
Organization Name:TABS BEHAVIORAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-612-2108
Mailing Address - Street 1:13316 VICARAGE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5050
Mailing Address - Country:US
Mailing Address - Phone:708-612-2108
Mailing Address - Fax:321-256-6380
Practice Address - Street 1:13316 VICARAGE DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5050
Practice Address - Country:US
Practice Address - Phone:708-612-2108
Practice Address - Fax:321-256-6380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2018001305OtherANCC