Provider Demographics
NPI:1760811905
Name:ADVANTAGE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:ADVANTAGE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF EAP SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DURPETTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-658-4224
Mailing Address - Street 1:1138 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-3482
Mailing Address - Country:US
Mailing Address - Phone:847-658-4224
Mailing Address - Fax:847-658-4226
Practice Address - Street 1:1138 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-3482
Practice Address - Country:US
Practice Address - Phone:847-658-4224
Practice Address - Fax:847-658-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL23496101YA0400X
IL180006721101YP2500X
IL1490087981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty