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General NPI Number Information
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NPI Number | 1871796797
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 33125 N US HIGHWAY 45
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City | GRAYSLAKE
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State | IL
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Zip | 60030-3901
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Country | US
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Telephone | 847-223-6123
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Fax |
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Provider Business Mailing Address
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Address Line | P O BOX 329
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City | WILDWOOD
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State | IL
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Zip | 60030-0329
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Country | US
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Telephone | 847-223-6123
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LINDA WETHERBE
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Credential | ED.D.
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Telephone | 847-223-6123
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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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