Provider Demographics
NPI:1962954495
Name:PLUM TREE PSYCHOLOGY LTD
Entity type:Organization
Organization Name:PLUM TREE PSYCHOLOGY LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-549-6245
Mailing Address - Street 1:511 ILLINOIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174
Mailing Address - Country:US
Mailing Address - Phone:630-549-6245
Mailing Address - Fax:630-701-9500
Practice Address - Street 1:511 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2152
Practice Address - Country:US
Practice Address - Phone:630-549-6245
Practice Address - Fax:630-701-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007631103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty