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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
1658 W GRAND AVE, CHICAGO, IL 60622-6309
(312) 491-3530
Mailing address
1150 N RIVER RD, DES PLAINES, IL 60016-1214
(847) 294-1999

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
261QM0850X
Adult Mental Health Clinic/Center
261QM0855X
Adolescent and Children Mental Health Clinic/Center

Other

Enumeration date
09/08/2016
Last updated
07/11/2022
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