Provider Demographics
NPI:1710047964
Name:THE THERAPY TREE D.B.A. BIRTH TO THREE & BEYOND PEDIATRIC THERAPIES
Entity Type:Organization
Organization Name:THE THERAPY TREE D.B.A. BIRTH TO THREE & BEYOND PEDIATRIC THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-265-7300
Mailing Address - Street 1:PO BOX 764
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-0764
Mailing Address - Country:US
Mailing Address - Phone:847-265-7300
Mailing Address - Fax:847-265-7301
Practice Address - Street 1:89 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-8411
Practice Address - Country:US
Practice Address - Phone:847-265-7300
Practice Address - Fax:847-265-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178003554101YM0800X
IL180004644101YM0800X
IL056006553174400000X
IL056005900174400000X
IL056007775174400000X
IL070002049174400000X
IL070010601174400000X
IL070014701174400000X
IL242000307235Z00000X
IL146005107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932271OtherBLUE SHIELD PROVIDER
IL=========OtherFEIN