Provider Demographics
NPI:1922375377
Name:NEUROPSYCHOLOGY CENTER FOR ATTENTION, BEHAVIOR & LEARNING, LLC
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGY CENTER FOR ATTENTION, BEHAVIOR & LEARNING, LLC
Other - Org Name:THE ABLE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICEMANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-573-8468
Mailing Address - Street 1:103 N REGENCY DR
Mailing Address - Street 2:SUITE 1S
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3503
Mailing Address - Country:US
Mailing Address - Phone:309-661-8046
Mailing Address - Fax:
Practice Address - Street 1:103 N REGENCY DR
Practice Address - Street 2:SUITE 1S
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3503
Practice Address - Country:US
Practice Address - Phone:309-661-8046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-007767103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty