Healthcare Provider Details

I. General information

NPI: 1578425807
Provider Name (Legal Business Name): VILTE BALIUTAVICIUTE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 W MONTROSE AVE STE 102
CHICAGO IL
60618-1562
US

IV. Provider business mailing address

2650 W MONTROSE AVE STE 102
CHICAGO IL
60618-1562
US

V. Phone/Fax

Practice location:
  • Phone: 708-480-2901
  • Fax:
Mailing address:
  • Phone: 773-377-5261
  • Fax: 872-813-4596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.017689
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: