Provider Demographics
NPI:1386203917
Name:HERBOTH THERAPY INC
Entity Type:Organization
Organization Name:HERBOTH THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBOTH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC, NCC
Authorized Official - Phone:217-259-2827
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:TEUTOPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62467-0453
Mailing Address - Country:US
Mailing Address - Phone:217-259-2827
Mailing Address - Fax:217-280-4323
Practice Address - Street 1:477 COUNTY ROAD 100 N
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:IL
Practice Address - Zip Code:62445-3019
Practice Address - Country:US
Practice Address - Phone:217-259-2827
Practice Address - Fax:217-280-4323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty