Healthcare Provider Details

I. General information

NPI: 1013839885
Provider Name (Legal Business Name): MAUREEN JESUTHASAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 N RAVENSWOOD AVE # 254
CHICAGO IL
60613-5651
US

IV. Provider business mailing address

3838 N RAVENSWOOD AVE # 254
CHICAGO IL
60613-5651
US

V. Phone/Fax

Practice location:
  • Phone: 773-837-6096
  • Fax:
Mailing address:
  • Phone: 773-837-6096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.032836
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: