Organization
THE MYRIAD AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINESHA D JOHNSON (CEO)
(773) 449-0859
Entity
Organization
Contact information
Practice address
5113 S HARPER AVE STE 2C, CHICAGO, IL 60615-4119
(773) 449-0859
Mailing address
5113 S HARPER AVE STE 2C, CHICAGO, IL 60615-4119
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
04/11/2024
Last updated
04/11/2024
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