| Organization Name: | OAK PARK BEHAVIORAL MEDICINE LLC |
| NPI Number: | 1003161225 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TIFFANY TAFT (OWNER) |
| Mailing Address: | 818 Harrison St Suite 210 Oak Park |
| State: | IL US |
| Postal Code: | 603041144 |
| Phone Number: | 3127256175 |
| Fax Number: | |
| NPI Enumeration Date: | 07/14/2012 |
| NPI Last Update Date: | 07/14/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 071008285 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |