Provider Demographics
NPI:1588839260
Name:BEVERLY BEHAVIORAL HEALTH, LTD
Entity Type:Organization
Organization Name:BEVERLY BEHAVIORAL HEALTH, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:E
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-779-9700
Mailing Address - Street 1:9933 S WESTERN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1810
Mailing Address - Country:US
Mailing Address - Phone:773-779-9700
Mailing Address - Fax:773-779-9732
Practice Address - Street 1:9933 S WESTERN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1810
Practice Address - Country:US
Practice Address - Phone:773-779-9700
Practice Address - Fax:773-779-9732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-009832261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health