MEDICARE: THE THRESHOLDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063715613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE THRESHOLDS

Provider Business Mailing Address
First Line	:	4101 N RAVENSWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2193
Country	:	US
Telephone Number	:	773-572-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3313
Country	:	US
Telephone Number	:	773-572-5500
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE ASSISTANT
Name	:	MARCELLA KLAUER
Credential	:
Telephone Number	:	773-572-5480

Provider Enumeration Date	:	12/20/2010
Last Update Date	:	07/14/2022

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Directions to “THE THRESHOLDS ” Practice Location

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