Provider Demographics
NPI:1215153853
Name:BEHAVORIAL HEALTH ASSOCIATES LTD
Entity type:Organization
Organization Name:BEHAVORIAL HEALTH ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOCKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-710-3493
Mailing Address - Street 1:PO BOX 2257
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-0357
Mailing Address - Country:US
Mailing Address - Phone:219-926-8320
Mailing Address - Fax:219-926-3524
Practice Address - Street 1:8 S MICHIGAN AVE
Practice Address - Street 2:STE 1203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3357
Practice Address - Country:US
Practice Address - Phone:773-710-3493
Practice Address - Fax:312-781-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005194103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-1854431OtherFEDERAL TAX ID
IL14-1854431OtherFEDERAL TAX ID