Provider Demographics
NPI:1487154365
Name:TEDD W. MCCAULEY, LCSW & ASSOCIATES, PC
Entity type:Organization
Organization Name:TEDD W. MCCAULEY, LCSW & ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TEDD
Authorized Official - Middle Name:WESTON
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-467-4937
Mailing Address - Street 1:24318 S PUEBLO DR
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-3206
Mailing Address - Country:US
Mailing Address - Phone:815-467-4937
Mailing Address - Fax:
Practice Address - Street 1:24735 W EAMES ST UNIT 11
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-8712
Practice Address - Country:US
Practice Address - Phone:815-290-5076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0061681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty