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General NPI Number Information
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NPI Number | 1982148334
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Entity Type | Organization
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Legal Business Name | CLAY THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 07/28/2021
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Provider Practice Location Address
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Address Line | 1325 REMINGTON RD STE O
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City | SCHAUMBURG
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State | IL
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Zip | 60173-4815
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Country | US
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Telephone | 224-633-9323
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Fax | 224-512-4914
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Provider Business Mailing Address
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Address Line | 1325 REMINGTON RD STE O
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City | SCHAUMBURG
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State | IL
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Zip | 60173-4815
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Country | US
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Telephone | 224-633-9323
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Fax | 847-490-5342
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Authorized Official
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Title or Position | MANAGER
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Name | KATHERINE JUOZAITIS
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Credential |
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Telephone | 815-325-1411
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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 | 180006912
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License Number State | IL
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