Provider Demographics
NPI:1760237424
Name:BEHAVIORAL HEALTH SPECIALIST OF CGH, PLLC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH SPECIALIST OF CGH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-407-4400
Mailing Address - Street 1:40 SKOKIE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1614
Mailing Address - Country:US
Mailing Address - Phone:224-407-4400
Mailing Address - Fax:224-407-2255
Practice Address - Street 1:40 SKOKIE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1614
Practice Address - Country:US
Practice Address - Phone:224-407-4400
Practice Address - Fax:224-407-2255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE GASTROINTESTINAL HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty