Healthcare Provider Details

I. General information

NPI: 1225285661
Provider Name (Legal Business Name): NICOLE MEYER KLARICH, LCPC & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 W. NORTH AVE. STE 1E
CHICAGO IL
60647
US

IV. Provider business mailing address

1700 N. ARTESIAN AVE - 1E
CHICAGO IL
60647
US

V. Phone/Fax

Practice location:
  • Phone: 773-524-2685
  • Fax: 773-524-2685
Mailing address:
  • Phone: 773-524-2685
  • Fax: 773-524-2685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180-005468
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number180-005468
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number180-005468
License Number StateIL

VIII. Authorized Official

Name: MS. NICOLE MEYER KLARICH
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCPC
Phone: 773-524-2685