Provider Demographics
NPI:1083423719
Name:THE WAY OUT THERAPEUTIC COUNSELING GROUP, PLLC
Entity type:Organization
Organization Name:THE WAY OUT THERAPEUTIC COUNSELING GROUP, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING THERAPIST/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-718-4503
Mailing Address - Street 1:10850 LINCOLN TRL UNIT 20-1861
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-0339
Mailing Address - Country:US
Mailing Address - Phone:314-718-4503
Mailing Address - Fax:618-416-2708
Practice Address - Street 1:10850 LINCOLN TRL UNIT 20-1861
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-0339
Practice Address - Country:US
Practice Address - Phone:314-718-4503
Practice Address - Fax:618-416-2708
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:T. C. FORD CONSULTING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.018180OtherIL DEPT OF FINANCIAL AND PROFESSIONAL REGULATION
MO2016002322OtherMO DIV OF PROFESSIONAL REGISTRATION
IL248.005531OtherIL DEPT OF FINANCIAL AND PROFESSIONAL REGULATION