Provider Demographics
NPI:1194068742
Name:OAKWOODS CENTER
Entity type:Organization
Organization Name:OAKWOODS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIDBURY
Authorized Official - Suffix:
Authorized Official - Credentials:MA LCPC
Authorized Official - Phone:708-481-5466
Mailing Address - Street 1:23500 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-2612
Mailing Address - Country:US
Mailing Address - Phone:708-481-5466
Mailing Address - Fax:708-481-5466
Practice Address - Street 1:23500 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-2612
Practice Address - Country:US
Practice Address - Phone:708-481-5466
Practice Address - Fax:708-481-5466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.002670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1588679971OtherNPI