Provider Demographics
NPI:1952726010
Name:BEHAVIORAL SERVICES CENTER
Entity Type:Organization
Organization Name:BEHAVIORAL SERVICES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SERVICES DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ISYANOV
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-922-4326
Mailing Address - Street 1:8707 SKOKIE BLVD
Mailing Address - Street 2:207
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2269
Mailing Address - Country:US
Mailing Address - Phone:847-673-8577
Mailing Address - Fax:
Practice Address - Street 1:25975 N DIAMOND LAKE RD
Practice Address - Street 2:SUITE111
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-9400
Practice Address - Country:US
Practice Address - Phone:847-673-8577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2016-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-1587-0007-A251S00000X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA-1587-0007-AOtherDASA