Provider Demographics
NPI:1841606811
Name:GORBOLD BEHAVIORAL CONSULTING, INC.
Entity Type:Organization
Organization Name:GORBOLD BEHAVIORAL CONSULTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-882-1024
Mailing Address - Street 1:484 W BOUGHTON RD STE C
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2478
Mailing Address - Country:US
Mailing Address - Phone:312-882-1024
Mailing Address - Fax:
Practice Address - Street 1:484 W BOUGHTON RD STE C
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2478
Practice Address - Country:US
Practice Address - Phone:312-882-1024
Practice Address - Fax:312-488-3663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty