Healthcare Provider Details

I. General information

NPI: 1265600183
Provider Name (Legal Business Name): TIMOTHY A O'DONOHUE LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 S FRONTAGE RD STE 36 SUITE 36
BURR RIDGE IL
60527-6169
US

IV. Provider business mailing address

241 S FRONTAGE RD STE 36
BURR RIDGE IL
60527-6169
US

V. Phone/Fax

Practice location:
  • Phone: 630-974-6777
  • Fax: 877-204-8581
Mailing address:
  • Phone: 630-974-6777
  • Fax: 877-204-8581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-002304
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: