Provider Demographics
NPI:1790314284
Name:ELEMENT THERAPY GROUP LLC
Entity Type:Organization
Organization Name:ELEMENT THERAPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:CELERIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-320-3245
Mailing Address - Street 1:3143 N SAWYER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6802
Mailing Address - Country:US
Mailing Address - Phone:773-320-3245
Mailing Address - Fax:
Practice Address - Street 1:3047 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4999
Practice Address - Country:US
Practice Address - Phone:773-245-6186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty