Organization
BREAKING FREE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HERBERT STRICKLIN M.S., LCPC (DIRECTOR OF CLINICAL OPERATIONS)
(630) 897-1003
Entity
Organization
Contact information
Practice address
120 GALE ST, SUITE 200, AURORA, IL 60506-5084
(630) 897-1003
(630) 572-0566
Mailing address
120 GALE ST, AURORA, IL 60506-5084
(308) 971-0036
(308) 971-0426
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
A-0380-0002-A
IL
251S00000X
Community/Behavioral Health Agency
—
IL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0380
DASA PROVIDER NUMBER
IL
01
—
1839
BLUE CROSS PROVIDER NUMBE
IL
Enumeration date
01/30/2007
Last updated
07/21/2020
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