Provider Demographics
NPI:1215398508
Name:MAKE YOUR MARK THERAPY, LLC
Entity Type:Organization
Organization Name:MAKE YOUR MARK THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICNESED CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-390-9833
Mailing Address - Street 1:1608 W COLONIAL PKWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:INVERNESS
Mailing Address - State:IL
Mailing Address - Zip Code:60067-4755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1608 W COLONIAL PKWY
Practice Address - Street 2:SUITE 207
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60067-4755
Practice Address - Country:US
Practice Address - Phone:630-390-9833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008991251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health