Healthcare Provider Details

I. General information

NPI: 1538833694
Provider Name (Legal Business Name): MGMT THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2728 CATON FARM RD
JOLIET IL
60435-1309
US

IV. Provider business mailing address

2728 CATON FARM RD
JOLIET IL
60435-1309
US

V. Phone/Fax

Practice location:
  • Phone: 815-714-8847
  • Fax:
Mailing address:
  • Phone: 815-714-8847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MEGHAN GRZETICH
Title or Position: OWNER
Credential: LMFT
Phone: 815-714-8847