Provider Demographics
NPI:1841873577
Name:OBSIDIAN BEHAVIORAL HEALTH PLLC
Entity type:Organization
Organization Name:OBSIDIAN BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVALIK BIANCHINI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LISW-CP
Authorized Official - Phone:630-296-4169
Mailing Address - Street 1:103 N 11TH AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2278
Mailing Address - Country:US
Mailing Address - Phone:630-296-4169
Mailing Address - Fax:630-296-9921
Practice Address - Street 1:103 N 11TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2278
Practice Address - Country:US
Practice Address - Phone:630-296-4169
Practice Address - Fax:630-296-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty