Provider Demographics
NPI:1790596385
Name:ST JOHN, THERON ROBERT
Entity type:Individual
Prefix:
First Name:THERON
Middle Name:ROBERT
Last Name:ST JOHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N ROSELLE RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3523
Mailing Address - Country:US
Mailing Address - Phone:317-512-0136
Mailing Address - Fax:
Practice Address - Street 1:200 N ROSELLE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3523
Practice Address - Country:US
Practice Address - Phone:317-512-0136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral