Organization
CEAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA ANN GOODMAN (BEHAVIOR TECHNICIAN)
(847) 648-3221
Entity
Organization
Contact information
Practice address
1100 MILLBROOK DR, LAKE ZURICH, IL 60047-2752
(847) 648-3221
Mailing address
1100 MILLBROOK DR, LAKE ZURICH, IL 60047-2752
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/14/2017
Last updated
04/14/2017
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