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Organization
SPEAKEASY THERAPY PLLC
Active
Organization
SPEAKEASY THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA MARIE WATERFIELD-COPELAND LCPC (OWNER)
(847) 476-1341
Entity
Organization
Contact information
Practice address
350 S NORTHWEST HWY STE 300, PARK RIDGE, IL 60068-4262
(847) 476-1341
Mailing address
350 S NORTHWEST HWY STE 300, PARK RIDGE, IL 60068-4262
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922536622
NPPES
—
Enumeration date
07/19/2022
Last updated
07/19/2022
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