=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023819042
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MY HAPPY PLACE THERAPIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2025
-----------------------------------------------------
Last Update Date | 03/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2S101 HARTER RD
-----------------------------------------------------
City | KANEVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60144-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-448-0221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 17
-----------------------------------------------------
City | KANEVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60144-0017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAMES BOYLE
-----------------------------------------------------
Credential | M.A., BCBA
-----------------------------------------------------
Telephone | 630-448-0221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------