Proactive Behavioral Services, Inc.
Organization Active NPI Clinical Psychologist · Inverness, IL
NPI 1043437049 · NPPES record last updated May 6, 2011
Key facts
- NPI
- 1043437049
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 071--007171 (IL)
- Legal business name
- PROACTIVE BEHAVIORAL SERVICES, INC.
- Practice address
- 1644 W. Colonial Pkwy.
Inverness, IL 60067-1207 - Phone
- (847) 776-4500
- Fax
- (847) 776-4724
- NPI assigned
- Apr 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Todd R. Lendvay, PSYD
- Title
- President/Owner
- Phone
- (847) 778-4500
Corporate family (same tax ID) 2
Practitioners 12
-
Andres Acosta, LCSW
-
Todd Russell Lendvay, PSY.D.
-
Jodi L Macaluso, MA LCPC CADC
-
William Puga, M.D.
-
Michael Rachman, MD
-
Mary Mary Gamlin, AGNP-C
-
Michael Handwerk, PHD
-
Mazhar Khan, PSYD
-
Marc I Oster, PSY.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080614000036 | IL | Part B Supplier - Clinic/Group Practice | 7618048950 |
Receives reassigned benefits from 10 practitioners Practice locations: Algonquin, IL |
National Provider Directory
- Tax ID family
- Proactive Behavioral Services Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | 071--007171 | IL | Yes |
Addresses
Primary practice location
1644 W. Colonial Pkwy.
Inverness, IL 60067-1207
Mailing address
1644 W. Colonial Pkwy.
Inverness, IL 60067-1207
Phone (847) 776-4500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04932629 | Other | BLUE CROSS |
Other providers in Inverness, IL
- Christopher Vincent Pelletiere
- Vincent James Pelletiere
- PKT Inc
- Positive Balance Wellness and Psychotherapy
- Positive Care Counseling LLC
- Jilian Prough
- Kristen C Pryor
- Katherine Reeg
- David Patrick Ritter
- Doris Romans
All providers in Inverness, IL · Clinical Psychologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.