Healthcare Provider Details

I. General information

NPI: 1912411893
Provider Name (Legal Business Name): BRIGGS THERAPY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W TALCOTT RD STE 26
PARK RIDGE IL
60068-5559
US

IV. Provider business mailing address

2 W TALCOTT RD STE 26
PARK RIDGE IL
60068-5559
US

V. Phone/Fax

Practice location:
  • Phone: 847-858-7277
  • Fax: 855-787-3065
Mailing address:
  • Phone: 847-858-7277
  • Fax: 855-787-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.008841
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.020545
License Number StateIL

VIII. Authorized Official

Name: MR. DAVID E. BRIGGS
Title or Position: OWNER/THERAPIST
Credential: LCPC
Phone: 847-858-7277