Provider Demographics
NPI:1154740975
Name:BEHAVIORAL PAIN MANAGEMENT, LLC
Entity type:Organization
Organization Name:BEHAVIORAL PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER / CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:AJEET
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHARATE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, BCN, CADC
Authorized Official - Phone:815-931-0047
Mailing Address - Street 1:12901 NORWICH ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-7908
Mailing Address - Country:US
Mailing Address - Phone:815-230-4707
Mailing Address - Fax:
Practice Address - Street 1:1220 HOBSON ROAD
Practice Address - Street 2:SUITE 244
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540
Practice Address - Country:US
Practice Address - Phone:815-931-0047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.005140101YP2500X
IL070009590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty