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Organization
TRANSFORMATION BEHAVIORAL HEALTH ASSOCIATES LLC
Active
Organization
TRANSFORMATION BEHAVIORAL HEALTH ASSOCIATES LLC
Active
Other names
Creative Alternatives for Psychological Growth LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY VINEHOUT PSYD (CLINICAL DIRECTOR)
(815) 245-6669
Entity
Organization
Contact information
Practice address
1090 MCCONNELL RD, WOODSTOCK, IL 60098-7310
(815) 245-6669
(815) 334-1640
Mailing address
PO BOX 1861, WOODSTOCK, IL 60098-1861
(815) 245-6669
(815) 334-1640
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071006683
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11894012
CAQH
IL
01
—
35641736
BCBS
IL
01
—
600016119
MAGELLAN
IL
Enumeration date
01/28/2013
Last updated
08/31/2015
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