Provider Demographics
NPI:1487995361
Name:PROACTIVE BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:PROACTIVE BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:LENDVAY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-776-4500
Mailing Address - Street 1:26112 W INDIAN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1344
Mailing Address - Country:US
Mailing Address - Phone:847-776-4500
Mailing Address - Fax:847-776-4724
Practice Address - Street 1:215 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-2448
Practice Address - Country:US
Practice Address - Phone:224-678-9033
Practice Address - Fax:224-678-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-02
Last Update Date:2013-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30204101YA0400X
IL178008534101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty