Provider Demographics
NPI:1821515123
Name:AG BEHAVIORAL HEALTH AND CONSULTING
Entity Type:Organization
Organization Name:AG BEHAVIORAL HEALTH AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-897-9695
Mailing Address - Street 1:977 LAKEVIEW PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061
Mailing Address - Country:US
Mailing Address - Phone:847-897-9695
Mailing Address - Fax:224-422-2304
Practice Address - Street 1:977 LAKEVIEW PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061
Practice Address - Country:US
Practice Address - Phone:847-897-9695
Practice Address - Fax:224-422-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490158151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty