| Oak Park Behavioral Medicine Llc | |
|
818 Harrison St Suite 210 Oak Park IL 60304-1144 | |
| (312) 725-6175 | |
| Not Available |
| Full Name | Oak Park Behavioral Medicine Llc |
|---|---|
| Speciality | Psychologist |
| Location | 818 Harrison St, Oak Park, Illinois |
| Authorized Official Name and Position | Tiffany Taft (OWNER) |
| Authorized Official Contact | 3127256175 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oak Park Behavioral Medicine Llc 824 S Grove Ave Oak Park IL 60304-1125 Ph: (312) 725-6175 | Oak Park Behavioral Medicine Llc 818 Harrison St Suite 210 Oak Park IL 60304-1144 Ph: (312) 725-6175 |
| NPI Number | 1003161225 |
|---|---|
| Provider Enumeration Date | 07/14/2012 |
| Last Update Date | 07/14/2012 |
| Medicare PECOS PAC ID | 3476787839 |
|---|---|
| Medicare Enrollment ID | O20131018000313 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003161225 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071008285 (Illinois) | Primary |
| Provider Name | Tiffany H Taft |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467714691 PECOS PAC ID: 0547406431 Enrollment ID: I20130419000293 |
| Provider Name | Colleen M Muchowski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710296058 PECOS PAC ID: 6709204191 Enrollment ID: I20200917000199 |
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