MEDICARE: DEEPWELL THERAPY PLLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1699632026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEEPWELL THERAPY PLLC

Provider Business Mailing Address
First Line	:	33 W HIGGINS RD STE 4060
Second Line	:
City	:	SOUTH BARRINGTON
State	:	IL
Zip	:	60010-9123
Country	:	US
Telephone Number	:	847-471-1356
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 W HIGGINS RD STE 4060
Second Line	:
City	:	SOUTH BARRINGTON
State	:	IL
Zip	:	60010-9123
Country	:	US
Telephone Number	:	847-471-1356
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MEGHAN BARRETT LUSE
Credential	:	LCPC
Telephone Number	:	847-471-1356

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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