Provider Demographics
NPI:1407549884
Name:MIDWEST THERAPY COLLECTIVE, LLC
Entity Type:Organization
Organization Name:MIDWEST THERAPY COLLECTIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, LCSW
Authorized Official - Phone:414-630-2011
Mailing Address - Street 1:49 BOONE VLG STE 103
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1231
Mailing Address - Country:US
Mailing Address - Phone:317-324-8415
Mailing Address - Fax:
Practice Address - Street 1:7043 COPPICE LN APT 7207
Practice Address - Street 2:
Practice Address - City:WHITESTOWN
Practice Address - State:IN
Practice Address - Zip Code:46075-9042
Practice Address - Country:US
Practice Address - Phone:317-324-8415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty