Organization
BEHAVIORAL SERVICES CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EUGENE ISYANOV LCPC (CLINICAL SERVICES DIRECTOR)
(847) 922-4326
Entity
Organization
Contact information
Practice address
25975 N DIAMOND LAKE RD, SUITE111, MUNDELEIN, IL 60060-9400
(847) 673-8577
Mailing address
8707 SKOKIE BLVD, 207, SKOKIE, IL 60077-2269
(847) 673-8577
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
A-1587-0007-A
IL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A-1587-0007-A
DASA
IL
Enumeration date
02/26/2014
Last updated
09/03/2016
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