Healthcare Provider Details

I. General information

NPI: 1609214154
Provider Name (Legal Business Name): TESSA R BEUKEMA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4256 N RAVENSWOOD AVE STE 310
CHICAGO IL
60613-1114
US

IV. Provider business mailing address

3051 N MILWAUKEE AVE UNIT 2
CHICAGO IL
60618-6612
US

V. Phone/Fax

Practice location:
  • Phone: 773-827-4791
  • Fax:
Mailing address:
  • Phone: 773-827-4791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180010864
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180010864
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180010864
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: