Provider Demographics
NPI:1598208241
Name:NEW CREATION THERAPEUTIC BODYWORK INC.
Entity Type:Organization
Organization Name:NEW CREATION THERAPEUTIC BODYWORK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRICE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-207-5537
Mailing Address - Street 1:1555 NAPERVILLE WHEATON RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8448
Mailing Address - Country:US
Mailing Address - Phone:630-207-5537
Mailing Address - Fax:888-873-1159
Practice Address - Street 1:1555 NAPERVILLE WHEATON RD
Practice Address - Street 2:SUITE 109
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8448
Practice Address - Country:US
Practice Address - Phone:630-207-5537
Practice Address - Fax:888-873-1159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty