Facts
- Status
- A
- Credential
- LCPC
- Type
- Individual
- Enumeration date
- 2023-05-26
- Last updated
- 2026-02-26
Specialties
Licenses
- License IL
- 180014330
Location
- Practice location
- 3100 DUNDEE RD STE 101
- City
- NORTHBROOK IL
- Postal code
- 600622462
- Phone
- 847-767-3999
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
Search this city from the state hub for other records in the public registry.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.