Provider Demographics
NPI:1710321229
Name:CENTER FOR NEUROBEHAVIORAL DISORDERS, LLC
Entity Type:Organization
Organization Name:CENTER FOR NEUROBEHAVIORAL DISORDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:217-877-1100
Mailing Address - Street 1:2490 N WATER ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4251
Mailing Address - Country:US
Mailing Address - Phone:217-877-1100
Mailing Address - Fax:217-877-1101
Practice Address - Street 1:2490 N WATER ST
Practice Address - Street 2:SUITE 9
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4251
Practice Address - Country:US
Practice Address - Phone:217-877-1100
Practice Address - Fax:217-877-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004726103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty