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General NPI Number Information
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NPI Number | 1275123861
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Entity Type | Organization
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Legal Business Name | THAT THERAPY PLACE, LLC
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Dates
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Enumeration Date | 01/19/2021
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 300 E WAR MEMORIAL DR STE 201A
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City | PEORIA
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State | IL
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Zip | 61614-7570
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Country | US
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Telephone | 309-310-2331
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Fax |
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Provider Business Mailing Address
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Address Line | 300 E WAR MEMORIAL DR STE 201A
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City | PEORIA
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State | IL
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Zip | 61614-7570
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Country | US
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Telephone | 309-310-2331
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | HILLARY J. WASSON
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Credential | LCSW
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Telephone | 309-431-2012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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