Healthcare Provider Details

I. General information

NPI: 1457704603
Provider Name (Legal Business Name): WHOLEHEALTH THERAPY PARTNERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 LAKE ST STE 410
OAK PARK IL
60301-1413
US

IV. Provider business mailing address

633 CARPENTER AVE
OAK PARK IL
60304-1104
US

V. Phone/Fax

Practice location:
  • Phone: 708-209-8987
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.004472
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number071008544
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number056003247
License Number StateIL

VIII. Authorized Official

Name: FRANK GERARD CZUBA
Title or Position: OWNER
Credential:
Phone: 708-209-5664