Provider Demographics
NPI:1316083231
Name:BEHAVIORAL HEALTH CARE ASSOCIATES LTD
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH CARE ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAISE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WOLFRUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-895-4540
Mailing Address - Street 1:1375 E SCHAUMBURG RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3658
Mailing Address - Country:US
Mailing Address - Phone:847-895-4540
Mailing Address - Fax:847-895-4544
Practice Address - Street 1:1375 E SCHAUMBURG RD
Practice Address - Street 2:SUITE 260
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3658
Practice Address - Country:US
Practice Address - Phone:847-895-4540
Practice Address - Fax:847-895-4544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103TB0200X, 2084P0800X, 101YA0400X
IL036079918103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036079918Medicaid
IL01619289OtherBC BS OF ILLINOIS
IL036079918Medicaid