Provider Demographics
NPI:1518418177
Name:THERAPY ETC
Entity Type:Organization
Organization Name:THERAPY ETC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-558-2722
Mailing Address - Street 1:1217 MCHENRY RD STE 236
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1379
Mailing Address - Country:US
Mailing Address - Phone:847-807-8777
Mailing Address - Fax:
Practice Address - Street 1:1217 MCHENRY RD STE 236
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1379
Practice Address - Country:US
Practice Address - Phone:847-807-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010603251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health