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General NPI Number Information
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NPI Number | 1609463157
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Entity Type | Organization
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Legal Business Name | DPS THERAPY GROUP LLC
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Dates
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Enumeration Date | 12/30/2020
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 3245 GROVE AVE BERWYN, IL 60402 SUITE 103
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City | BERWYN
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State | IL
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Zip | 60402
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Country | US
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Telephone | 708-955-1522
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Fax |
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Provider Business Mailing Address
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Address Line | 3245 GROVE AVE, SUITE 103
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City | BERWYN
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State | IL
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Zip | 60402
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Country | US
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Telephone | 708-955-1522
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/LCPC
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Name | MRS. DENISE SANDOVAL
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Credential | LCPC
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Telephone | 708-955-1522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health 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 | 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 #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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