Provider Demographics
NPI:1699008946
Name:CHICAGO BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:CHICAGO BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:FARKAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:866-943-9977
Mailing Address - Street 1:155 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 760
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7511
Mailing Address - Country:US
Mailing Address - Phone:866-943-9977
Mailing Address - Fax:928-833-7155
Practice Address - Street 1:155 N MICHIGAN AVE
Practice Address - Street 2:SUITE 760
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7511
Practice Address - Country:US
Practice Address - Phone:866-943-9977
Practice Address - Fax:928-833-7155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004346261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202160Medicare PIN