Healthcare Provider Details

I. General information

NPI: 1558217042
Provider Name (Legal Business Name): IN HERVENTION THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25210 W JACKSON LN
PLAINFIELD IL
60586-7240
US

IV. Provider business mailing address

2501 CHATHAM RD STE N
SPRINGFIELD IL
62704-4188
US

V. Phone/Fax

Practice location:
  • Phone: 708-320-9224
  • Fax:
Mailing address:
  • Phone: 708-320-9224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA ROBERTSON
Title or Position: OWNER
Credential: LCPC
Phone: 309-445-1844