Provider Demographics
NPI:1275123861
Name:THAT THERAPY PLACE, LLC
Entity Type:Organization
Organization Name:THAT THERAPY PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WASSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:309-431-2012
Mailing Address - Street 1:300 E WAR MEMORIAL DR STE 201A
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-7570
Mailing Address - Country:US
Mailing Address - Phone:309-310-2331
Mailing Address - Fax:
Practice Address - Street 1:300 E WAR MEMORIAL DR STE 201A
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-7570
Practice Address - Country:US
Practice Address - Phone:309-310-2331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health