Provider Demographics
NPI:1619377637
Name:LANTERN THERAPY SERVICES, LTD
Entity Type:Organization
Organization Name:LANTERN THERAPY SERVICES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRISY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-503-9018
Mailing Address - Street 1:457 COVENTRY LN STE 129A
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7571
Mailing Address - Country:US
Mailing Address - Phone:815-503-9018
Mailing Address - Fax:779-423-0778
Practice Address - Street 1:457 COVENTRY LN STE 129A
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7571
Practice Address - Country:US
Practice Address - Phone:815-503-9018
Practice Address - Fax:779-423-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007379101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty