Provider Demographics
NPI:1629744099
Name:THERAPY HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:THERAPY HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-354-1767
Mailing Address - Street 1:921 S HUMPHREY AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1720
Mailing Address - Country:US
Mailing Address - Phone:773-354-1767
Mailing Address - Fax:
Practice Address - Street 1:1010 LAKE ST STE 200
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1132
Practice Address - Country:US
Practice Address - Phone:773-354-1767
Practice Address - Fax:844-444-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty