Organization
BEHAVIORAL SERVICES CENTER
Active
Organization
BEHAVIORAL SERVICES CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EUGENE ISYANOV LCPC (CLINICAL SERVICES DIRECTOR)
(847) 673-8577
Entity
Organization
Contact information
Practice address
2021 MIDWEST RD STE 200, OAK BROOK, IL 60523-1370
(847) 673-8577
Mailing address
8707 SKOKIE BLVD, SUITE 207, SKOKIE, IL 60077-2269
(847) 673-8577
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
A-1587-0009-A
IL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A-1587-0009-A
DASA
IL
Enumeration date
02/26/2014
Last updated
07/01/2022
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