MEDICARE: WHOLEHEALTH THERAPY PARTNERS, 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
1	103TH0004X	Health Psychologist	071008544	IL
2	251E00000X	Home Health Agency	056003247	IL
3	101YP2500X	Professional Counselor	180.004472	IL

General Provider Information

NPI Number	:	1457704603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLEHEALTH THERAPY PARTNERS, INC

Provider Business Mailing Address
First Line	:	633 CARPENTER AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60304-1104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 LAKE ST STE 410
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60301-1413
Country	:	US
Telephone Number	:	708-209-8987
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FRANK GERARD CZUBA
Credential	:
Telephone Number	:	708-209-5664

Provider Enumeration Date	:	07/22/2016
Last Update Date	:	12/09/2016

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