Provider Demographics
NPI:1811267198
Name:BELGRADE BEHAVIOR CONSULTING, LLC
Entity type:Organization
Organization Name:BELGRADE BEHAVIOR CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELGRADE-MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, BCBA
Authorized Official - Phone:773-407-1121
Mailing Address - Street 1:4801 W PETERSON AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5713
Mailing Address - Country:US
Mailing Address - Phone:773-407-1121
Mailing Address - Fax:773-588-3374
Practice Address - Street 1:4801 W PETERSON AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5713
Practice Address - Country:US
Practice Address - Phone:773-407-1121
Practice Address - Fax:773-588-3374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-5011103K00000X
IL180-002740101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty