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NPI Code Detail

MEDICARE: THE TABOR THERAPY GROUP, INC.

MEDICARE: THE TABOR THERAPY GROUP, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023546710
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE TABOR THERAPY GROUP, INC.
Provider Business Mailing Address
First Line : 5404 W ELM ST STE H
Second Line :
City : MCHENRY
State : IL
Zip : 60050-4007
Country : US
Telephone Number : 815-331-8768
Fax Number : 815-331-8760
Provider Business Practice Location Address
First Line : 5404 W ELM ST STE H
Second Line :
City : MCHENRY
State : IL
Zip : 60050-4007
Country : US
Telephone Number : 815-331-8768
Fax Number : 815-331-8760
Authorized Official
Title or Position : CHIEF MEDICAL OFFICER
Name : ELLIOTT RICHELSON
Credential : M.D.
Telephone Number : 941-444-1730
Provider Enumeration Date : 05/25/2017
Last Update Date : 05/03/2022

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