Provider Demographics
NPI:1730201971
Name:CENTER FOR BEHAVIORAL HEALTH & WELLNESS, LLC
Entity type:Organization
Organization Name:CENTER FOR BEHAVIORAL HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RITU
Authorized Official - Middle Name:DEVENDRA
Authorized Official - Last Name:TRIVEDI-PUROHIT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-296-3484
Mailing Address - Street 1:549 IVORY LN
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1230
Mailing Address - Country:US
Mailing Address - Phone:630-540-9495
Mailing Address - Fax:
Practice Address - Street 1:1440 RENAISSANCE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1356
Practice Address - Country:US
Practice Address - Phone:847-296-3484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty