MEDICARE: HISPANIC THERAPEUTIC SERVICES CORP

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	:	1598551095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HISPANIC THERAPEUTIC SERVICES CORP

Provider Business Mailing Address
First Line	:	5719 W FULLERTON AVE APT 1F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-2337
Country	:	US
Telephone Number	:	773-865-2384
Fax Number	:

Provider Business Practice Location Address
First Line	:	5719 W FULLERTON AVE APT 1F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-2337
Country	:	US
Telephone Number	:	773-865-2384
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NORMA MARTINEZ
Credential	:	LSW
Telephone Number	:	773-865-2384

Provider Enumeration Date	:	04/19/2025
Last Update Date	:	11/13/2025

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