Organization
QUALITY BEHAVIORAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYRIAM TILLMAN (PRESIDENT)
(773) 484-6796
Entity
Organization
Contact information
Practice address
3400 S INDIANA AVE, CHICAGO, IL 60616-3841
(773) 684-4282
Mailing address
12420 S LAFLIN ST, CALUMET PARK, IL 60827-5713
(773) 484-6796
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
149004649
IL
Other
Enumeration date
02/12/2015
Last updated
02/12/2015
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