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Organization
WILDWOOD THERAPY LLC
Active
Organization
WILDWOOD THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY BETH G JOHNSON LCPC (OWNER)
(920) 445-6050
Entity
Organization
Contact information
Practice address
6437 N MAGNOLIA AVE APT 1, CHICAGO, IL 60626-5305
(920) 445-6050
Mailing address
6437 N MAGNOLIA AVE APT 1, CHICAGO, IL 60626-5305
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
11/11/2021
Last updated
11/11/2021
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