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Organization
TRISTATE WELLNESS MGT LLC
Active
Organization
TRISTATE WELLNESS MGT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP DOUGLAS THOMPSON (PROGRAM DIRECTOR)
(708) 646-5738
Entity
Organization
Contact information
Practice address
2826 N TALMAN, UNIT J, CHICAGO, IL 60618-7828
(708) 646-5738
(866) 587-1485
Mailing address
2826 N TALMAN, UNIT J, CHICAGO, IL 60618-7828
(708) 646-5738
(866) 587-1485
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
036093462
IL
103TC0700X
Clinical Psychologist
336-008797
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036039387
—
IL
05
—
036093462
—
IL
Enumeration date
05/23/2006
Last updated
01/08/2008
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