Provider Demographics
NPI:1952497935
Name:BRANDT THERAPY CLINICS, INC.
Entity Type:Organization
Organization Name:BRANDT THERAPY CLINICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:LAURENE
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MS
Authorized Official - Phone:630-456-4411
Mailing Address - Street 1:889 ASBURY LN
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-4101
Mailing Address - Country:US
Mailing Address - Phone:630-290-3384
Mailing Address - Fax:
Practice Address - Street 1:125 E LAKE ST
Practice Address - Street 2:SUITE 106
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1179
Practice Address - Country:US
Practice Address - Phone:630-307-3782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006083101YP2500X
IL1041C0700X
IL166000532106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001635417OtherBLUE CROSS BLUE SHIELD
IL34398000OtherMAGELLAN