Provider Demographics
NPI:1902145964
Name:SEGAL BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:SEGAL BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAY
Authorized Official - Middle Name:SEGAL,
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-943-9068
Mailing Address - Street 1:770 LAKE COOK RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4920
Mailing Address - Country:US
Mailing Address - Phone:847-943-9068
Mailing Address - Fax:
Practice Address - Street 1:770 LAKE COOK RD
Practice Address - Street 2:SUITE 270
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4920
Practice Address - Country:US
Practice Address - Phone:847-943-9068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008509103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty