Organization · Type 2 NPI

Western Lake

Community/Behavioral Health Agency · Fox Lake, IL

NPI number 1992893010 Active

Practice location

21 W Grand Ave
Fox Lake, IL 60020-1209

Fax (847) 587-8584

Specialties and licenses

Taxonomy	Code	License
Community/Behavioral Health Agency Primary	251S00000X	A-1450-0002-A (IL)

Community/Behavioral Health Agency: A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day suppo…

NPI record

NPI: 1992893010
Entity type: Organization (Type 2)
Issued: Oct 11, 2006
Last updated: Jul 16, 2008
Status: Active

Other names

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Counseling & Dui Programs LLC · former legal business name

Authorized official

Mr. Jeff Roy Hedien, MA NCC CADC
Director/ Sole MBR Owner
(847) 587-9700

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1992893010

Western Lake's National Provider Identifier is 1992893010, issued on Oct 11, 2006. The primary taxonomy on file is Community/Behavioral Health Agency (251S00000X), and the practice location is in Fox Lake, IL. The record was last updated on Jul 16, 2008.