MGM Therapy & Behavioral Treatment Corporation

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

MGM THERAPY & BEHAVIORAL TREATMENT CORPORATION

Practice address

12856 S Paulina St
Calumet Park, IL 60827-5951

Phone

(708) 724-5898

NPI assigned

Jul 26, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Michelle Glynise Moore, DTNPI 1760649628

Title

Developmental Therapy

Phone

(708) 698-0714

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michelle Glynise Moore, EARLY INTERVENTION P

  • Clinical Social Worker
  • Blue Island, IL
  • NPI 1760649628

  Early Intervention Provider Agency

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469577600000",
    "number": "1215480207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 658",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604060658",
            "telephone_number": "708-724-5898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12856 S PAULINA ST",
            "city": "CALUMET PARK",
            "state": "IL",
            "postal_code": "608275951",
            "telephone_number": "708-724-5898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MGM THERAPY & BEHAVIORAL TREATMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-26",
        "last_updated": "2016-07-27",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "GLYNISE",
        "authorized_official_title_or_position": "DEVELOPMENTAL THERAPY",
        "authorized_official_telephone_number": "708-698-0714",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "DT"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Vernon Johnson Jr., CDL CLASS A
• Tracey Johnson
• Lolita a. Wilburn D.C.P.C.
• Victoria Elizabeth Lopez
• Sharon McBride-Lindsey
• Midwest Express Care 2, Inc
• Andrea Moore
• Shybella Morgan
• Brianna Neal, LSW
• Kristie Sue Paprocki, SLP

• Early Intervention Provider Agency in Calumet Park, IL
• Providers in Calumet Park, IL by specialty
• Early Intervention Provider Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.