MEDICARE: THE THERAPLAY INSTITUTE

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	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1639498504	OTHER	IL	NPI#

General Provider Information

NPI Number	:	1639498504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE THERAPLAY INSTITUTE

Provider Business Mailing Address
First Line	:	1224 W BELMONT AVE FL 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3207
Country	:	US
Telephone Number	:	847-256-7334
Fax Number	:	847-256-7337

Provider Business Practice Location Address
First Line	:	1224 W BELMONT AVE FL 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3207
Country	:	US
Telephone Number	:	847-256-7334
Fax Number	:	847-256-7337

Authorized Official
Title or Position	:	CLINIC MANAGER
Name	:	ZAYA A GILLOGLY
Credential	:	LCSW
Telephone Number	:	224-850-3069

Provider Enumeration Date	:	05/18/2010
Last Update Date	:	03/29/2023

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Directions to “THE THERAPLAY INSTITUTE ” Practice Location

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