Associated Behavioral Consultants, Inc

Primary specialty

Group Psychotherapy PsychologistTaxonomy code 103TP2701X

License

149001505 Issued in IL

Legal business name

ASSOCIATED BEHAVIORAL CONSULTANTS, INC

Practice address

4835 W Irving Park Rd
Chicago, IL 60641-2719

Phone

(773) 777-7413

NPI assigned

May 19, 2006

Organization subpart

No

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

Authorized official

Name

Fred T Waltzer, LCSW

Title

President

Phone

(773) 777-7413

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224460800000",
    "number": "1760436398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4835 W IRVING PARK RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606412719",
            "telephone_number": "773-777-7413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4835 W IRVING PARK RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606412719",
            "telephone_number": "773-777-7413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATED BEHAVIORAL CONSULTANTS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2008-10-20",
        "status": "A",
        "authorized_official_last_name": "WALTZER",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-777-7413",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "IL",
            "license": "149001505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36332274-60712-01",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 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.