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NPI Code Detail

MEDICARE: NEW DIRECTIONS THERAPY, LTD.

MEDICARE: NEW DIRECTIONS THERAPY, LTD.
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
1251S00000XCommunity/Behavioral Health Agency
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1205474475
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEW DIRECTIONS THERAPY, LTD.
Provider Business Mailing Address
First Line : 40 E 9TH ST APT 1901
Second Line :
City : CHICAGO
State : IL
Zip : 60605-2152
Country : US
Telephone Number : 847-456-8687
Fax Number :
Provider Business Practice Location Address
First Line : 10725 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60643-3217
Country : US
Telephone Number : 630-686-2015
Fax Number : 312-284-1031
Authorized Official
Title or Position : PRESIDENT
Name : DENNIS A. KLACKO
Credential : LCPC
Telephone Number : 630-686-2015
Provider Enumeration Date : 12/18/2019
Last Update Date : 12/18/2019

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Directions to “NEW DIRECTIONS THERAPY, LTD. ” Practice Location

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