Organization
CCL THERAPEUTIC SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. COLLEEN CLARK LAY LCSW (PRESIDENT)
(630) 688-0289
Entity
Organization
Contact information
Practice address
9620 US ROUTE 34, SUITE E, YORKVILLE, IL 60560-1394
(630) 688-0289
Mailing address
9620 US ROUTE 34, SUITE E, YORKVILLE, IL 60560-1394
(630) 688-0289
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149010985
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149010985
STATE CLINICAL LICENSE
IL
Enumeration date
05/14/2007
Last updated
10/04/2012
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