Provider Demographics
NPI:1568751725
Name:BEHAVIORAL MEDICINE INSTITUTE
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:HUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-998-1015
Mailing Address - Street 1:875 N MICHIGAN AVE STE 3100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1962
Mailing Address - Country:US
Mailing Address - Phone:312-998-1015
Mailing Address - Fax:312-794-7801
Practice Address - Street 1:875 N MICHIGAN AVE STE 3100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1962
Practice Address - Country:US
Practice Address - Phone:312-998-1015
Practice Address - Fax:312-794-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-28
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007323103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty