MEDICARE: IN HERVENTION THERAPY PLLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1558217042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN HERVENTION THERAPY PLLC

Provider Business Mailing Address
First Line	:	2501 CHATHAM RD STE N
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-4188
Country	:	US
Telephone Number	:	708-320-9224
Fax Number	:

Provider Business Practice Location Address
First Line	:	25210 W JACKSON LN
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60586-7240
Country	:	US
Telephone Number	:	708-320-9224
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTINA ROBERTSON
Credential	:	LCPC
Telephone Number	:	309-445-1844

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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