Healthcare Provider Details

I. General information

NPI: 1093577025
Provider Name (Legal Business Name): RISE AND SHINE THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 S MCLEAN BLVD STE C
SOUTH ELGIN IL
60177-1833
US

IV. Provider business mailing address

81 S MCLEAN BLVD STE C
SOUTH ELGIN IL
60177-1833
US

V. Phone/Fax

Practice location:
  • Phone: 630-596-3688
  • Fax:
Mailing address:
  • Phone: 630-596-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALISON L ANDREWS
Title or Position: CLINICAL SOCIAL WORKER/THERAPIST
Credential: LCSW
Phone: 847-421-4597