Provider Demographics
NPI:1316780703
Name:MILLENNIUM BEHAVIOR HEALTH SERVICES
Entity type:Organization
Organization Name:MILLENNIUM BEHAVIOR HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:CAADC/LASOP
Authorized Official - Phone:773-306-2975
Mailing Address - Street 1:2441 W. 79TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-1734
Mailing Address - Country:US
Mailing Address - Phone:773-306-2975
Mailing Address - Fax:872-267-7166
Practice Address - Street 1:2441 W. 79TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-1734
Practice Address - Country:US
Practice Address - Phone:773-306-2975
Practice Address - Fax:872-267-7166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center