Provider Demographics
NPI:1477091189
Name:MARIANNE TOMLINSON THERAPY, LLC
Entity type:Organization
Organization Name:MARIANNE TOMLINSON THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCP
Authorized Official - Phone:630-337-6571
Mailing Address - Street 1:1605 W WILSON ST STE 111
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1682
Mailing Address - Country:US
Mailing Address - Phone:630-337-6571
Mailing Address - Fax:
Practice Address - Street 1:1605 W WILSON ST STE 111
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1682
Practice Address - Country:US
Practice Address - Phone:630-337-6571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIANNE TOMLINSON THERAPY,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0190161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty