Healthcare Provider Details

I. General information

NPI: 1992425771
Provider Name (Legal Business Name): BIRCHWOOD THERAPUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3012 HAVEN COURT
JOLIET IL
60435
US

IV. Provider business mailing address

2364 ESSINGTON RD # 313
JOLIET IL
60435-1664
US

V. Phone/Fax

Practice location:
  • Phone: 815-348-9438
  • Fax:
Mailing address:
  • Phone: 815-348-9438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KARI M FITZGERALD
Title or Position: OWNER
Credential: LCPC
Phone: 773-354-1970