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Contact Information

MADISON BERESFORD
265 EXCHANGE DR
SUITE 101B
CRYSTAL LAKE, IL60014-6230
 Phone: 224-286-4673
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pastoral

101YP1600X
 

Counselor

101Y00000X
 

Mental Health

101YM0800X
Indicates primary specialty

NPI Profile & details for MADISON BERESFORD · (Male)

NPI Number 1215392659
Status Active
Credentials
Entity Individual
Enumeration date 12/30/2015
Last updated 01/04/2016 - About 10 years ago
Sole proprietor 1 No
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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