Provider Demographics
NPI:1639350044
Name:INSTITUTE FOR HEALTH BEHAVIOR CHANGE INC.
Entity Type:Organization
Organization Name:INSTITUTE FOR HEALTH BEHAVIOR CHANGE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHENEL
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:ELLECOM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, DRPH
Authorized Official - Phone:630-654-1377
Mailing Address - Street 1:621 PLAINFIELD RD STE 110
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5385
Mailing Address - Country:US
Mailing Address - Phone:630-654-1377
Mailing Address - Fax:630-654-2575
Practice Address - Street 1:621 PLAINFIELD RD STE 110
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5385
Practice Address - Country:US
Practice Address - Phone:630-654-1377
Practice Address - Fax:630-654-2575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71-5240103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty