NPIMap

Organization Active NPI

Maryville Academy

Doing business as Family Behavioral Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chicago, IL
National Provider Identifier
1902353782
Registry record updated Jul 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
MARYVILLE ACADEMY
Doing business as
Family Behavioral Health Clinic
Practice address
1658 W Grand Ave
Chicago, IL 60622-6309
Phone
(312) 491-3530
NPI assigned
Sep 8, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2022

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

Authorized official

Name
Nancy Z Woulfe
Title
Director of Business Development
Phone
(847) 294-1910

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

1658 W Grand Ave
Chicago, IL 60622-6309

Mailing address

1150 N River Rd
Des Plaines, IL 60016-1214
Phone (847) 294-1999

Other names 1

  • Family Behavioral Health Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Maryville Academy28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Locations

1658 W Grand Ave
Chicago, IL 60622
Phone (312) 491-3500

NPI Registry JSON

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

{
    "created_epoch": "1473292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657497600000",
    "number": "1902353782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 N RIVER RD",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600161214",
            "telephone_number": "847-294-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1658 W GRAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606226309",
            "telephone_number": "312-491-3530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYVILLE ACADEMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-08",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A",
        "authorized_official_last_name": "WOULFE",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "Z",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS DEVELOPMENT",
        "authorized_official_telephone_number": "847-294-1910"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Behavioral Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Behavioral Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2022; 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.