Provider Demographics
NPI:1396121976
Name:STUBNAR BEHAVIORAL SERVICES CORPORATION
Entity type:Organization
Organization Name:STUBNAR BEHAVIORAL SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:STUBNAR
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:618-201-1146
Mailing Address - Street 1:451 W WRIGHTWOOD AVE
Mailing Address - Street 2:#913
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1882
Mailing Address - Country:US
Mailing Address - Phone:618-201-1146
Mailing Address - Fax:
Practice Address - Street 1:451 W WRIGHTWOOD AVE
Practice Address - Street 2:#913
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1882
Practice Address - Country:US
Practice Address - Phone:618-201-1146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-07-3682103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty