Provider Demographics
NPI:1821537358
Name:THE ANXIETY TREATMENT CENTER - WESTERN SUBURBS, LLC
Entity Type:Organization
Organization Name:THE ANXIETY TREATMENT CENTER - WESTERN SUBURBS, LLC
Other - Org Name:THE OCD & ANXIETY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-522-3124
Mailing Address - Street 1:1100 JORIE BLVD STE 132
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-4402
Mailing Address - Country:US
Mailing Address - Phone:630-522-3124
Mailing Address - Fax:
Practice Address - Street 1:1100 JORIE BLVD
Practice Address - Street 2:227
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523
Practice Address - Country:US
Practice Address - Phone:630-522-3124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty