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General NPI Number Information
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NPI Number | 1639534829
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Entity Type | Organization
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Legal Business Name | RENAISSANCE THERAPY SERVICES
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 20200 GOVERNORS DR STE 201E
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1056
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Country | US
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Telephone | 872-205-6710
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Fax |
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Provider Business Mailing Address
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Address Line | 18710 HARDING AVE
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City | FLOSSMOOR
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State | IL
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Zip | 60422-1052
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Country | US
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Telephone | 708-552-6085
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GEORGIA SOLTAU
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Credential |
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Telephone | 708-552-6085
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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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