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General NPI Number Information
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NPI Number | 1205743549
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Entity Type | Organization
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Legal Business Name | MANIFEST THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 15635 S 94TH AVE STE 114
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City | ORLAND PARK
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State | IL
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Zip | 60462-4722
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Country | US
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Telephone | 708-949-6867
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Fax |
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Provider Business Mailing Address
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Address Line | 15635 S 94TH AVE STE 114
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City | ORLAND PARK
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State | IL
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Zip | 60462-4722
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Country | US
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Telephone | 708-949-6867
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Fax | 708-667-1110
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Authorized Official
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Title or Position | PRESIDENT
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Name | GINA L TAPELLA
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Credential | LCSW
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Telephone | 815-685-2103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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