Provider Demographics
NPI:1174269542
Name:MENTAL AND EMOTIONAL HEALING THERAPY PLLC
Entity Type:Organization
Organization Name:MENTAL AND EMOTIONAL HEALING THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-220-4994
Mailing Address - Street 1:737 GARFIELD AVE APT B
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3187
Mailing Address - Country:US
Mailing Address - Phone:847-220-4994
Mailing Address - Fax:
Practice Address - Street 1:737 GARFIELD AVE APT B
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3187
Practice Address - Country:US
Practice Address - Phone:224-725-3004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty