Healthcare Provider Details

I. General information

NPI: 1659809853
Provider Name (Legal Business Name): SANJUANA MEZA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 W CENTRAL RD
ARLINGTON HEIGHTS IL
60005-2410
US

IV. Provider business mailing address

1865 SEQUOIA DR
HANOVER PARK IL
60133-3982
US

V. Phone/Fax

Practice location:
  • Phone: 847-385-5042
  • Fax:
Mailing address:
  • Phone: 224-431-3263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180015605
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: