Provider Demographics
NPI:1285635532
Name:THERAPY PLUS PC
Entity Type:Organization
Organization Name:THERAPY PLUS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRENO
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:773-316-5305
Mailing Address - Street 1:4733 N DAMEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1442
Mailing Address - Country:US
Mailing Address - Phone:773-743-4881
Mailing Address - Fax:773-751-2878
Practice Address - Street 1:4733 N DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1442
Practice Address - Country:US
Practice Address - Phone:773-743-4881
Practice Address - Fax:773-751-2878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-010042174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL325782922001Medicaid
IL325782922001Medicaid