Healthcare Provider Details

I. General information

NPI: 1831766419
Provider Name (Legal Business Name): KEIKO IZUMI LCPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N. MICHIGAN AVE SUITE 810
CHICAGO IL
60601
US

IV. Provider business mailing address

205 N. MICHIGAN AVE., SUITE 810
CHICAGO IL
60601
US

V. Phone/Fax

Practice location:
  • Phone: 312-857-8009
  • Fax:
Mailing address:
  • Phone: 312-857-8009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.014665
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.014808
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180014665
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: