NPI 1215480207

Mgm Therapy & Behavioral Treatment Corporation

Organisation Early Intervention Provider Agency Calumet Park, IL

Practice location

Address: 12856 S Paulina St, Calumet Park, IL 60827-5951
Phone: (708) 724-5898
Mailing address: PO Box 658, Blue Island, IL 60406-0658

Authorised official

Name: Michelle Glynise Moore
Title: Developmental Therapy
Phone: (708) 698-0714

Registered specialties

Early Intervention Provider Agency Primary

Agencies Taxonomy 252Y00000X

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Registry record

NPI: 1215480207
Entity type: Organization
NPI issued: 26 Jul 2016
Record last updated: 27 Jul 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.