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General NPI Number Information
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NPI Number | 1356368195
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Entity Type | Organization
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Legal Business Name | WOLFE BEHAVIORAL HEALTH P.C.
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 02/12/2008
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Provider Practice Location Address
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Address Line | 339 ALANA DR
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City | NEW LENOX
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State | IL
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Zip | 60451-1766
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Country | US
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Telephone | 815-462-3827
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Fax | 815-462-3837
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Provider Business Mailing Address
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Address Line | 683 JULI DR
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City | NEW LENOX
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State | IL
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Zip | 60451-1269
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Country | US
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Telephone | 815-462-3827
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Fax | 815-462-3837
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. DORA MARIE WOLFE
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Credential | PSYD
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Telephone | 815-462-3827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State | IL
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