Provider Demographics
NPI:1588052831
Name:CENTER FOR BEHAVIORAL MEDICINE
Entity type:Organization
Organization Name:CENTER FOR BEHAVIORAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-569-0285
Mailing Address - Street 1:25 E WASHINGTON ST
Mailing Address - Street 2:SUITE 1225
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1708
Mailing Address - Country:US
Mailing Address - Phone:312-569-0285
Mailing Address - Fax:312-245-3124
Practice Address - Street 1:25 E WASHINGTON ST
Practice Address - Street 2:SUITE 1225
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1708
Practice Address - Country:US
Practice Address - Phone:312-569-0285
Practice Address - Fax:312-245-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490171771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty