1053539494 NPI number — BIOFEEDBACK & FAMILY THERAPY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053539494 NPI number — BIOFEEDBACK & FAMILY THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIOFEEDBACK & FAMILY THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053539494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
231 S WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60540-4656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-913-3239
Provider Business Mailing Address Fax Number:
630-332-8151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60540-4656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-913-3239
Provider Business Practice Location Address Fax Number:
630-332-8151
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MAHAN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
630-913-1627

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  166000634 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0002232702 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com