Provider Demographics
NPI:1801477799
Name:INDIVIDUAL ADVOCACY GROUP, INC.
Entity type:Organization
Organization Name:INDIVIDUAL ADVOCACY GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HEBER
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-759-0201
Mailing Address - Street 1:1289 WINDHAM PKWY
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-1763
Mailing Address - Country:US
Mailing Address - Phone:630-759-0201
Mailing Address - Fax:
Practice Address - Street 1:30 PHELPS AVE
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-1335
Practice Address - Country:US
Practice Address - Phone:815-372-8950
Practice Address - Fax:815-372-8960
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIVIDUAL ADVOCACY GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-21
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health