Organization
MGM THERAPY & BEHAVIORAL TREATMENT CORPORATION
Active
Organization
MGM THERAPY & BEHAVIORAL TREATMENT CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE GLYNISE MOORE DT (DEVELOPMENTAL THERAPY)
(708) 698-0714
Entity
Organization
Contact information
Practice address
12856 S PAULINA ST, CALUMET PARK, IL 60827-5951
(708) 724-5898
Mailing address
PO BOX 658, BLUE ISLAND, IL 60406-0658
(708) 724-5898
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
07/26/2016
Last updated
07/27/2016
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