Medical Behavioral Center

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

MEDICAL BEHAVIORAL CENTER

Practice address

21936 Burnham Ave
Sauk Village, IL 60411-5204

Phone

(708) 753-0685

NPI assigned

May 14, 2014

Last updated

May 14, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kyle Gill

Title

Adminstrator

Phone

(708) 753-0685

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1400025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400025600000",
    "number": "1881005635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21936 BURNHAM AVE",
            "city": "SAUK VILLAGE",
            "state": "IL",
            "postal_code": "604115204",
            "telephone_number": "708-753-0685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21936 BURNHAM AVE",
            "city": "SAUK VILLAGE",
            "state": "IL",
            "postal_code": "604115204",
            "telephone_number": "708-753-0685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL BEHAVIORAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-14",
        "last_updated": "2014-05-14",
        "status": "A",
        "authorized_official_last_name": "GILL",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "ADMINSTRATOR",
        "authorized_official_telephone_number": "708-753-0685"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2014; 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.