MEDICARE: THE ZEN THERAPY ROOM LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1609522887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ZEN THERAPY ROOM LLC

Provider Business Mailing Address
First Line	:	171 SANTA FE LN
Second Line	:
City	:	WILLOW SPRINGS
State	:	IL
Zip	:	60480-1624
Country	:	US
Telephone Number	:	630-601-8660
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 SANTA FE LN
Second Line	:
City	:	WILLOW SPRINGS
State	:	IL
Zip	:	60480-1624
Country	:	US
Telephone Number	:	630-334-7858
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CATHERINE WATKINS
Credential	:
Telephone Number	:	630-601-8660

Provider Enumeration Date	:	02/25/2022
Last Update Date	:	08/04/2022

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