Healthcare Provider Details

I. General information

NPI: 1912440249
Provider Name (Legal Business Name): CRYSTAL LYNN HRESKA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W GOLF RD STE 59C
ARLINGTON HEIGHTS IL
60005-3923
US

IV. Provider business mailing address

1004 W MINER ST
ARLINGTON HEIGHTS IL
60005-1229
US

V. Phone/Fax

Practice location:
  • Phone: 847-999-3579
  • Fax: 224-404-1089
Mailing address:
  • Phone: 773-454-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180010654
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: