Provider Demographics
NPI:1255755096
Name:ASSOCIATES IN BEHAVIORAL HEALTH CARE
Entity type:Organization
Organization Name:ASSOCIATES IN BEHAVIORAL HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRICK
Authorized Official - Suffix:
Authorized Official - Credentials:CADC MISA I MATTP
Authorized Official - Phone:847-791-4384
Mailing Address - Street 1:309 PHEASANT TRL
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-1357
Mailing Address - Country:US
Mailing Address - Phone:847-791-4384
Mailing Address - Fax:847-426-5384
Practice Address - Street 1:783 8TH STREET
Practice Address - Street 2:CENTURY PLAZA
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118
Practice Address - Country:US
Practice Address - Phone:847-791-4384
Practice Address - Fax:847-426-5384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA-5029-0002-AOtherIL DASA LICENSE