Institute for Health Behavior Change Inc.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

71-5240 Issued in IL

Legal business name

INSTITUTE FOR HEALTH BEHAVIOR CHANGE INC.

Practice address

621 Plainfield Rd Ste 110
Willowbrook, IL 60527-5385

Phone

(630) 654-1377

Fax

(630) 654-2575

NPI assigned

Nov 14, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Richenel Samuel Ellecom, PSY.D, DR.P.H.

Title

President/Owner

Phone

(630) 654-1377

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202860800000",
    "number": "1639350044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 PLAINFIELD RD STE 110",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605275385",
            "telephone_number": "630-654-1377",
            "fax_number": "630-654-2575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 PLAINFIELD RD STE 110",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605275385",
            "telephone_number": "630-654-1377",
            "fax_number": "630-654-2575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE FOR HEALTH BEHAVIOR CHANGE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-14",
        "last_updated": "2008-02-13",
        "status": "A",
        "authorized_official_last_name": "ELLECOM",
        "authorized_official_first_name": "RICHENEL",
        "authorized_official_middle_name": "SAMUEL",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "630-654-1377",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D, DR.P.H."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "IL",
            "license": "71-5240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neuropsychologist in Willowbrook, IL
• Providers in Willowbrook, IL by specialty
• Clinical Neuropsychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.