Provider Demographics
NPI:1215536693
Name:MIRACLEWORKS THERAPY & CONSULTING PLLC
Entity Type:Organization
Organization Name:MIRACLEWORKS THERAPY & CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRACLE
Authorized Official - Middle Name:DONIQUE
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:310-849-4786
Mailing Address - Street 1:51 E 14TH ST APT 1008
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2998
Mailing Address - Country:US
Mailing Address - Phone:310-849-4786
Mailing Address - Fax:
Practice Address - Street 1:51 E 14TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2837
Practice Address - Country:US
Practice Address - Phone:872-228-5573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-18
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty