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General NPI Number Information
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NPI Number | 1790399319
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Entity Type | Organization
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Legal Business Name | NORTHWEST TREATMENT ASSOCIATES
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 645 MCHENRY AVE
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City | WOODSTOCK
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State | IL
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Zip | 60098-2922
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Country | US
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Telephone | 815-337-1234
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Fax | 815-337-5653
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Provider Business Mailing Address
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Address Line | 645 MCHENRY AVE
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City | WOODSTOCK
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State | IL
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Zip | 60098-2922
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Country | US
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Telephone | 815-337-1234
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Fax | 815-337-5653
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | GEORGIA ELLEN FLEMING
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Credential |
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Telephone | 847-608-8570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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