Fresh Start Behaviorial Center

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

36093329 Issued in IL

Legal business name

FRESH START BEHAVIORIAL CENTER

Practice address

8 Surrey Brook PLZ
Sauk Village, IL 60411-4913

Phone

(708) 757-2444

Fax

(708) 757-2449

NPI assigned

Jun 9, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joel K Carroll, DO

Title

Medical Director

Phone

(708) 757-2444

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1184883779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 SURREY BROOK PLZ",
            "city": "SAUK VILLAGE",
            "state": "IL",
            "postal_code": "604114913",
            "telephone_number": "708-757-2444",
            "fax_number": "708-757-2449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 SURREY BROOK PLZ",
            "city": "SAUK VILLAGE",
            "state": "IL",
            "postal_code": "604114913",
            "telephone_number": "708-757-2444",
            "fax_number": "708-757-2449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH START BEHAVIORIAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-09",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "708-757-2444",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "36093329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dr Marilyn D Jackson & Associates LTD
• Milton K Draper
• Taiwo Fadekemi Durowade
• Curtis J Edwards
• Johnie Mae Epps
• Paula Galmore
• Shaun Reeves Gary, MOTR/L
• Rozine Gibson
• Brenda Frances Harris, SLP-L
• Owin S. Henry

• All providers in Sauk Village, IL
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.