Provider Demographics
NPI:1003600511
Name:MIRACLEWORKS THERAPY & CONSULTING INC
Entity type:Organization
Organization Name:MIRACLEWORKS THERAPY & CONSULTING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MIRACLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:310-849-4786
Mailing Address - Street 1:51 E 14TH ST APT 1008
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2998
Mailing Address - Country:US
Mailing Address - Phone:310-849-4786
Mailing Address - Fax:872-250-2826
Practice Address - Street 1:51 E 14TH ST APT 1008
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2998
Practice Address - Country:US
Practice Address - Phone:310-849-4786
Practice Address - Fax:872-250-2826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty