Provider Demographics
NPI:1730777350
Name:CENTER FOR COMPREHENSIVE NEUROBEHAVIORAL CARE
Entity type:Organization
Organization Name:CENTER FOR COMPREHENSIVE NEUROBEHAVIORAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:G
Authorized Official - Last Name:TALL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:801-953-4371
Mailing Address - Street 1:65 E WACKER PL STE 300
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7203
Mailing Address - Country:US
Mailing Address - Phone:801-953-4371
Mailing Address - Fax:
Practice Address - Street 1:65 E WACKER PL STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7203
Practice Address - Country:US
Practice Address - Phone:801-953-4371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty