Provider Demographics
NPI:1053539494
Name:BIOFEEDBACK & FAMILY THERAPY LLC
Entity type:Organization
Organization Name:BIOFEEDBACK & FAMILY THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-913-1627
Mailing Address - Street 1:231 S WASHINGTON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-4656
Mailing Address - Country:US
Mailing Address - Phone:630-913-3239
Mailing Address - Fax:630-332-8151
Practice Address - Street 1:231 S WASHINGTON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-4656
Practice Address - Country:US
Practice Address - Phone:630-913-3239
Practice Address - Fax:630-332-8151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000634106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002232702OtherBLUE CROSS BLUE SHIELD