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General NPI Number Information
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NPI Number | 1386203917
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Entity Type | Organization
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Legal Business Name | HERBOTH THERAPY INC
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Dates
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Enumeration Date | 06/07/2019
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Last Update Date | 06/07/2019
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Provider Practice Location Address
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Address Line | 477 COUNTY ROAD 100 N
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City | MONTROSE
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State | IL
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Zip | 62445-3019
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Country | US
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Telephone | 217-259-2827
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Fax | 217-280-4323
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Provider Business Mailing Address
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Address Line | PO BOX 453
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City | TEUTOPOLIS
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State | IL
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Zip | 62467-0453
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Country | US
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Telephone | 217-259-2827
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Fax | 217-280-4323
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Authorized Official
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Title or Position | OWNER
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Name | HOLLY HERBOTH
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Credential | MS, LCPC, NCC
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Telephone | 217-259-2827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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