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General NPI Number Information
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NPI Number | 1376230656
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Entity Type | Organization
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Legal Business Name | MICAH CALDWELL THERAPY PLLC
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 3440 CLINTON AVE
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City | BERWYN
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State | IL
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Zip | 60402-3322
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Country | US
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Telephone | 708-695-4841
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Fax |
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Provider Business Mailing Address
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Address Line | 7301 W 25TH ST # 130
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City | NORTH RIVERSIDE
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State | IL
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Zip | 60546-1409
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MICAH CALDWELL
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Credential | LCPC
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Telephone | 708-695-4841
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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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