Healthcare Provider Details

I. General information

NPI: 1124568340
Provider Name (Legal Business Name): RIKKI CASAS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RIKKI CARLIN

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3338 N LINCOLN AVE
CHICAGO IL
60657-1108
US

IV. Provider business mailing address

3338 N LINCOLN AVE
CHICAGO IL
60657-1108
US

V. Phone/Fax

Practice location:
  • Phone: 708-320-9679
  • Fax:
Mailing address:
  • Phone: 708-320-9679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180012928
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: