Western Lake

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

A-1450-0002-A Issued in IL

Legal business name

WESTERN LAKE

Practice address

21 W Grand Ave
Fox Lake, IL 60020-1209

Phone

(847) 587-9700

Fax

(847) 587-8584

NPI assigned

Oct 11, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Jeff Roy Hedien, MA NCC CADC

Title

Director/ Sole MBR Owner

Phone

(847) 587-9700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• COUNSELING & DUI PROGRAMS LLC Former legal business name

Locations

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216166400000",
    "number": "1992893010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 W GRAND AVE",
            "city": "FOX LAKE",
            "state": "IL",
            "postal_code": "600201209",
            "telephone_number": "847-587-9700",
            "fax_number": "847-587-8584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 W GRAND AVE",
            "city": "FOX LAKE",
            "state": "IL",
            "postal_code": "600201209",
            "telephone_number": "847-587-9700",
            "fax_number": "847-587-8584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN LAKE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2008-07-16",
        "status": "A",
        "authorized_official_last_name": "HEDIEN",
        "authorized_official_first_name": "JEFF",
        "authorized_official_middle_name": "ROY",
        "authorized_official_title_or_position": "DIRECTOR/ SOLE MBR OWNER",
        "authorized_official_telephone_number": "847-587-9700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA NCC CADC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "A-1450-0002-A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF HUMAN SERVICES OFFICE OF ALCOHOL & SUBSTANCE ABUSE (DHS/DASA)",
            "identifier": "A 1450 0002 A",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COUNSELING & DUI PROGRAMS LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Community/Behavioral Health Agency in Fox Lake, IL
• Providers in Fox Lake, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.