Organization
MARYVILLE ACADEMY
Active
Organization
MARYVILLE ACADEMY
Active
Other names
Family Behavioral Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY Z WOULFE (DIRECTOR OF BUSINESS DEVELOPMENT)
(847) 294-1910
Entity
Organization
Contact information
Practice address
1510 N CLAREMONT AVE, CHICAGO, IL 60622-1710
(312) 491-3509
(312) 391-3531
Mailing address
1455 E GOLF RD STE 210, DES PLAINES, IL 60016-1254
(847) 390-3004
(847) 390-3016
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
12/14/2017
Last updated
12/14/2017
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