| Pebblebrook Pediatric Behavioral Therapy, Llc | |
|
1301 Pyott Rd Ste 106 Lake In The Hills IL 60156-9796 | |
| (847) 752-0046 | |
| (224) 678-9886 |
| Full Name | Pebblebrook Pediatric Behavioral Therapy, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1301 Pyott Rd Ste 106, Lake In The Hills, Illinois |
| Authorized Official Name and Position | Jennifer D Rice (OWNER/BCBA) |
| Authorized Official Contact | 8477520046 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pebblebrook Pediatric Behavioral Therapy, Llc 1301 Pyott Rd Ste 106 Lake In The Hills IL 60156-9796 Ph: (847) 752-0046 | Pebblebrook Pediatric Behavioral Therapy, Llc 1301 Pyott Rd Ste 106 Lake In The Hills IL 60156-9796 Ph: (847) 752-0046 |
| NPI Number | 1285146092 |
|---|---|
| Provider Enumeration Date | 11/02/2017 |
| Last Update Date | 08/19/2021 |
| Certification Date | 08/19/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285146092 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-17-27622 (Illinois) | Primary |
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