MEDICARE: TOTALITY. THERAPIES LLC

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)

General Provider Information

NPI Number	:	1144837055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTALITY. THERAPIES LLC

Provider Business Mailing Address
First Line	:	2027 W DIVISION ST STE 157
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-9024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2027 W DIVISION ST STE 157
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-9024
Country	:	US
Telephone Number	:	708-320-8992
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JACKIE BOUSEK
Credential	:
Telephone Number	:	708-320-8992

Provider Enumeration Date	:	09/24/2020
Last Update Date	:	09/24/2020

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Directions to “TOTALITY. THERAPIES LLC ” Practice Location

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