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General NPI Number Information
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NPI Number | 1548882822
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Entity Type | Organization
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Legal Business Name | JOSEPH BOZIC THERAPY, LLC
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Dates
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Enumeration Date | 05/10/2020
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 8600 US HIGHWAY 14
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City | CRYSTAL LAKE
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State | IL
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Zip | 60012-2706
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Country | US
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Telephone | 847-845-7953
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Fax |
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Provider Business Mailing Address
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Address Line | 1410 GRANDVIEW CT
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City | ALGONQUIN
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State | IL
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Zip | 60102-1995
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Country | US
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Telephone | 847-845-7953
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH G BOZIC
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Credential | LMFT
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Telephone | 847-845-7953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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