Provider Demographics
NPI:1538312475
Name:ILLINOIS BEHAVIORAL SERVICES INC
Entity Type:Organization
Organization Name:ILLINOIS BEHAVIORAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLOGG WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-473-6420
Mailing Address - Street 1:276 EAST 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411
Mailing Address - Country:US
Mailing Address - Phone:708-473-6420
Mailing Address - Fax:
Practice Address - Street 1:276 E 16TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60471
Practice Address - Country:US
Practice Address - Phone:708-473-6420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty