Provider Demographics
NPI:1356709398
Name:THY X MY
Entity type:Organization
Organization Name:THY X MY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-923-5838
Mailing Address - Street 1:585 THORNHILL DR
Mailing Address - Street 2:UNIT 215
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2764
Mailing Address - Country:US
Mailing Address - Phone:630-923-5838
Mailing Address - Fax:
Practice Address - Street 1:585 THORNHILL DR
Practice Address - Street 2:UNIT 215
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2764
Practice Address - Country:US
Practice Address - Phone:630-923-5838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009724251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health