Healthcare Provider Details

I. General information

NPI: 1700142452
Provider Name (Legal Business Name): THERAPEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N FAIRWAY DR STE 208
VERNON HILLS IL
60061-1803
US

IV. Provider business mailing address

200 N FAIRWAY DR STE 208
VERNON HILLS IL
60061-1803
US

V. Phone/Fax

Practice location:
  • Phone: 847-996-6666
  • Fax:
Mailing address:
  • Phone: 847-996-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.004942
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166.000652
License Number StateIL

VIII. Authorized Official

Name: HILARY DAVIS
Title or Position: MARRIAGE & FAMILY THERAPIST
Credential: MFT, LPC
Phone: 773-450-4541