Provider Demographics
NPI:1790220820
Name:LONG GROVE CENTER FOR EMOTIONAL HEALTH LLC
Entity Type:Organization
Organization Name:LONG GROVE CENTER FOR EMOTIONAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-830-8600
Mailing Address - Street 1:4180 RFD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047
Mailing Address - Country:US
Mailing Address - Phone:847-830-8600
Mailing Address - Fax:847-821-1218
Practice Address - Street 1:4180 RFD
Practice Address - Street 2:SUITE 10
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047
Practice Address - Country:US
Practice Address - Phone:847-830-8600
Practice Address - Fax:847-821-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005290101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty