| Collaborative Behavioral Health Llc | |
|
4711 Golf Rd Suite 1200 Skokie IL 60076-1224 | |
| (847) 922-3253 | |
| (847) 679-8002 |
| Full Name | Collaborative Behavioral Health Llc |
|---|---|
| Speciality | Psychologist |
| Location | 4711 Golf Rd, Skokie, Illinois |
| Authorized Official Name and Position | Michael Edward Topel (MANAGER) |
| Authorized Official Contact | 8479223253 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Collaborative Behavioral Health Llc 4711 Golf Rd Ste 1200 Skokie IL 60076-1200 Ph: (847) 922-3253 | Collaborative Behavioral Health Llc 4711 Golf Rd Suite 1200 Skokie IL 60076-1224 Ph: (847) 922-3253 |
| NPI Number | 1194190520 |
|---|---|
| Provider Enumeration Date | 12/10/2015 |
| Last Update Date | 05/05/2020 |
| Certification Date | 05/05/2020 |
| Medicare PECOS PAC ID | 9739442369 |
|---|---|
| Medicare Enrollment ID | O20200806001087 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194190520 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071.008824 (Illinois) | Primary |
| 363A00000X | Physician Assistant | 085001699 (Illinois) | Secondary |
| Provider Name | Michael Edward Topel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1861704207 PECOS PAC ID: 7810214889 Enrollment ID: I20180413000618 |
| Provider Name | Mollyrose M Kelly |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386126449 PECOS PAC ID: 7911324926 Enrollment ID: I20240523001613 |
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