Provider Demographics
NPI:1871796797
Name:THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WETHERBE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:847-223-6123
Mailing Address - Street 1:P O BOX 329
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60030-0329
Mailing Address - Country:US
Mailing Address - Phone:847-223-6123
Mailing Address - Fax:
Practice Address - Street 1:33125 N US HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-3901
Practice Address - Country:US
Practice Address - Phone:847-223-6123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004915117OtherBLUE CROSS BLUE SHIELD
IL0004915117OtherBLUE CROSS BLUE SHIELD