Healthcare Provider Details

I. General information

NPI: 1205474475
Provider Name (Legal Business Name): NEW DIRECTIONS THERAPY, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10725 S WESTERN AVE
CHICAGO IL
60643-3217
US

IV. Provider business mailing address

40 E 9TH ST APT 1901
CHICAGO IL
60605-2152
US

V. Phone/Fax

Practice location:
  • Phone: 630-686-2015
  • Fax: 312-284-1031
Mailing address:
  • Phone: 847-456-8687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DENNIS A. KLACKO
Title or Position: PRESIDENT
Credential: LCPC
Phone: 630-686-2015