MEDICARE: THE THERAPY CENTER INCORPORATED

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	:	1801488838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE THERAPY CENTER INCORPORATED

Provider Business Mailing Address
First Line	:	7000 PIPER GLEN DR STE C
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-7390
Country	:	US
Telephone Number	:	217-483-7104
Fax Number	:	217-483-7109

Provider Business Practice Location Address
First Line	:	7000 PIPER GLEN DR STE C
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-7390
Country	:	US
Telephone Number	:	217-483-7104
Fax Number	:	217-483-7109

Authorized Official
Title or Position	:	CEO
Name	:	VICKIE HUFFMAN PRUITT
Credential	:	LCPC
Telephone Number	:	121-836-0341

Provider Enumeration Date	:	02/10/2021
Last Update Date	:	02/10/2021

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Directions to “THE THERAPY CENTER INCORPORATED ” Practice Location

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