Provider Demographics
NPI:1629480587
Name:THE TABOR THERAPY GROUP, INC
Entity Type:Organization
Organization Name:THE TABOR THERAPY GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TABOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-529-5933
Mailing Address - Street 1:5404 W ELM ST STE H
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4007
Mailing Address - Country:US
Mailing Address - Phone:815-331-8768
Mailing Address - Fax:815-331-8760
Practice Address - Street 1:5404 W ELM ST STE H
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4007
Practice Address - Country:US
Practice Address - Phone:815-331-8768
Practice Address - Fax:815-331-8760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.011675251S00000X
261QC1500X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)