Healthcare Provider Details

I. General information

NPI: 1477308815
Provider Name (Legal Business Name): THERAPEUTIC SOLUTIONS OF MACOMB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 S DEER RD
MACOMB IL
61455-2602
US

IV. Provider business mailing address

460 S DEER RD
MACOMB IL
61455-2602
US

V. Phone/Fax

Practice location:
  • Phone: 309-333-9829
  • Fax:
Mailing address:
  • Phone: 309-575-3960
  • Fax: 309-575-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER SMITH
Title or Position: OWNER
Credential: LCSW
Phone: 309-575-3960