Provider Demographics
NPI:1659736064
Name:THERAPEUTIC MEDICAL SERVICE PROVIDERS TMSP CHARTERED
Entity Type:Organization
Organization Name:THERAPEUTIC MEDICAL SERVICE PROVIDERS TMSP CHARTERED
Other - Org Name:TMSP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELWOOD
Authorized Official - Middle Name:P
Authorized Official - Last Name:NYTHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-818-9607
Mailing Address - Street 1:10809 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-3409
Mailing Address - Country:US
Mailing Address - Phone:773-818-9607
Mailing Address - Fax:
Practice Address - Street 1:10809 S STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-3409
Practice Address - Country:US
Practice Address - Phone:773-818-9607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149001874104100000X
IL149.0046941041C0700X
IL149.0066941041C0700X
IL1490018671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty