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General NPI Number Information
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NPI Number | 1205474475
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Entity Type | Organization
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Legal Business Name | NEW DIRECTIONS THERAPY, LTD.
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Dates
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Enumeration Date | 12/18/2019
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 10725 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-3217
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Country | US
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Telephone | 630-686-2015
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Fax | 312-284-1031
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Provider Business Mailing Address
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Address Line | 40 E 9TH ST APT 1901
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City | CHICAGO
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State | IL
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Zip | 60605-2152
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Country | US
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Telephone | 847-456-8687
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENNIS A. KLACKO
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Credential | LCPC
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Telephone | 630-686-2015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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