Healthcare Provider Details

I. General information

NPI: 1003435934
Provider Name (Legal Business Name): THE TABOR THERAPY GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12151 REGENCY PKWY STE 12169
HUNTLEY IL
60142-7644
US

IV. Provider business mailing address

5404 W ELM ST STE H
MCHENRY IL
60050-4007
US

V. Phone/Fax

Practice location:
  • Phone: 815-331-8768
  • Fax:
Mailing address:
  • Phone: 815-331-8768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ANN TABOR
Title or Position: OWNER
Credential:
Phone: 815-331-8768