Provider Demographics
NPI:1962857193
Name:BEHAVIORAL SERVICES CENTER
Entity Type:Organization
Organization Name:BEHAVIORAL SERVICES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ISYANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-673-8577
Mailing Address - Street 1:8707 SKOKIE BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2272
Mailing Address - Country:US
Mailing Address - Phone:847-673-8577
Mailing Address - Fax:
Practice Address - Street 1:310 S GREENLEAF ST STE 205
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:847-673-8577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)