Provider Demographics
NPI:1700052305
Name:BEHAVIOR MODIFICATION CLINIC, LTD.
Entity Type:Organization
Organization Name:BEHAVIOR MODIFICATION CLINIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:STRAUBE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:815-385-5903
Mailing Address - Street 1:5435 BULL VALLEY RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7434
Mailing Address - Country:US
Mailing Address - Phone:815-385-5903
Mailing Address - Fax:
Practice Address - Street 1:5435 BULL VALLEY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7434
Practice Address - Country:US
Practice Address - Phone:815-385-5903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001146251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health