Provider Demographics
NPI:1932578234
Name:KHALIL CENTER
Entity Type:Organization
Organization Name:KHALIL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOOMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHAVARZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-622-3116
Mailing Address - Street 1:999 N MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-3581
Mailing Address - Country:US
Mailing Address - Phone:630-474-4414
Mailing Address - Fax:
Practice Address - Street 1:999 N MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-3581
Practice Address - Country:US
Practice Address - Phone:630-474-4414
Practice Address - Fax:630-230-3364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008541101YP2500X
IL178.010934101YP2500X
IL180009783101YP2500X
IL071007457103TC0700X
IL0360933192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty