Provider Demographics
NPI:1053110734
Name:WEST SUBURBS OCD AND MENTAL HEALTH THERAPY LLC
Entity type:Organization
Organization Name:WEST SUBURBS OCD AND MENTAL HEALTH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOFRIO-BALLIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-201-0681
Mailing Address - Street 1:913 62ND ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-1902
Mailing Address - Country:US
Mailing Address - Phone:630-201-0681
Mailing Address - Fax:
Practice Address - Street 1:913 62ND ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-1902
Practice Address - Country:US
Practice Address - Phone:630-201-0681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty