Provider Demographics
NPI:1669878823
Name:MERIDIAN BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:MERIDIAN BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:HARDIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-810-5646
Mailing Address - Street 1:2800 N SHERIDAN RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6156
Mailing Address - Country:US
Mailing Address - Phone:773-331-7690
Mailing Address - Fax:847-559-9348
Practice Address - Street 1:2800 N SHERIDAN RD
Practice Address - Street 2:SUITE 108
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:773-331-7690
Practice Address - Fax:847-559-9348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty