Healthcare Provider Details

I. General information

NPI: 1073624060
Provider Name (Legal Business Name): JOHN CHARLES ZIBERT PH.D; LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6536 N ASHLAND AVE
CHICAGO IL
60626-4907
US

IV. Provider business mailing address

6536 N ASHLAND AVE
CHICAGO IL
60626-4907
US

V. Phone/Fax

Practice location:
  • Phone: 773-960-2762
  • Fax: 888-635-6531
Mailing address:
  • Phone: 773-960-2762
  • Fax: 888-635-6531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180-004874
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: