Provider Demographics
NPI:1679229348
Name:BERRYBROOK CRISIS RESOLUTION LLC
Entity Type:Organization
Organization Name:BERRYBROOK CRISIS RESOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DYKSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CADC, SAP, MAC
Authorized Official - Phone:708-549-5616
Mailing Address - Street 1:7819 W 159TH ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1343
Mailing Address - Country:US
Mailing Address - Phone:708-549-5616
Mailing Address - Fax:
Practice Address - Street 1:7819 W 159TH ST
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1343
Practice Address - Country:US
Practice Address - Phone:708-549-5616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder