Provider Demographics
NPI:1306220256
Name:SECOND STORIES THERAPEUTIC INTERVENTIONS
Entity Type:Organization
Organization Name:SECOND STORIES THERAPEUTIC INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYDNEI
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODLY
Authorized Official - Suffix:
Authorized Official - Credentials:MA LCPC
Authorized Official - Phone:479-841-8786
Mailing Address - Street 1:1121 WARREN AVE
Mailing Address - Street 2:260A
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3570
Mailing Address - Country:US
Mailing Address - Phone:773-513-9414
Mailing Address - Fax:
Practice Address - Street 1:1121 WARREN AVE
Practice Address - Street 2:260A
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3570
Practice Address - Country:US
Practice Address - Phone:773-513-9414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008261101YP2500X
IL180007268101YP2500X
IL178008081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty