Provider Demographics
NPI:1063769354
Name:BOZIC, JOSEPH GEORGE (AMFT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GEORGE
Last Name:BOZIC
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 GRANDVIEW CT
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-1995
Mailing Address - Country:US
Mailing Address - Phone:847-845-7953
Mailing Address - Fax:
Practice Address - Street 1:8600 US HIGHWAY 14
Practice Address - Street 2:STE 110
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-2706
Practice Address - Country:US
Practice Address - Phone:815-444-9210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000264106H00000X
IL166000972106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist