Provider Demographics
NPI:1780222901
Name:MOMENTUM BEHAVIOR SERVICES LLC
Entity Type:Organization
Organization Name:MOMENTUM BEHAVIOR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:708-227-0793
Mailing Address - Street 1:1999 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2101
Mailing Address - Country:US
Mailing Address - Phone:708-227-0793
Mailing Address - Fax:
Practice Address - Street 1:1999 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-2101
Practice Address - Country:US
Practice Address - Phone:708-227-0793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty