Healthcare Provider Details

I. General information

NPI: 1700627288
Provider Name (Legal Business Name): WILLS THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 W BUTTERFIELD RD
ELMHURST IL
60126-5069
US

IV. Provider business mailing address

PO BOX 1967
OAK PARK IL
60304-0607
US

V. Phone/Fax

Practice location:
  • Phone: 708-722-6117
  • Fax:
Mailing address:
  • Phone:
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALEXANDRA M WILLS
Title or Position: OWNER
Credential: LCPC
Phone: 708-722-6117