Provider Demographics
NPI:1205284767
Name:MTW CLINICAL THERAPY SERVICES
Entity type:Organization
Organization Name:MTW CLINICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:WOOLEVER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-618-0812
Mailing Address - Street 1:1250 N MILL ST STE 102A
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-6305
Mailing Address - Country:US
Mailing Address - Phone:630-618-0812
Mailing Address - Fax:630-246-6046
Practice Address - Street 1:1250 N MILL ST STE 102A
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-6305
Practice Address - Country:US
Practice Address - Phone:630-618-0812
Practice Address - Fax:630-246-6046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010299101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty