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General NPI Number Information
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NPI Number | 1205284767
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Entity Type | Organization
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Legal Business Name | MTW CLINICAL THERAPY SERVICES
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 1250 N MILL ST STE 102A
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City | NAPERVILLE
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State | IL
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Zip | 60563-6305
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Country | US
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Telephone | 630-618-0812
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Fax | 630-246-6046
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Provider Business Mailing Address
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Address Line | 1250 N MILL ST STE 102A
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City | NAPERVILLE
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State | IL
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Zip | 60563-6305
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Country | US
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Telephone | 630-618-0812
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Fax | 630-246-6046
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA THERESA WOOLEVER
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Credential | LCPC
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Telephone | 630-618-0812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180010299
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License Number State | IL
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