Provider Demographics
NPI:1700222429
Name:ANCHOR BEHAVIORAL CENTERS, INC.
Entity Type:Organization
Organization Name:ANCHOR BEHAVIORAL CENTERS, INC.
Other - Org Name:ANCHOR CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTALVO-NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CADC
Authorized Official - Phone:312-254-5085
Mailing Address - Street 1:79 W MONROE ST
Mailing Address - Street 2:SUITE 920
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-4901
Mailing Address - Country:US
Mailing Address - Phone:312-254-5085
Mailing Address - Fax:
Practice Address - Street 1:79 W MONROE ST
Practice Address - Street 2:SUITE 920
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-4901
Practice Address - Country:US
Practice Address - Phone:312-254-5085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 103TP2701X, 1041C0700X
ILA-5654-0001-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty