Healthcare Provider Details

I. General information

NPI: 1972448595
Provider Name (Legal Business Name): LUCIA DAVALOS TERRAZAS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 S DAMEN AVE
CHICAGO IL
60608-4209
US

IV. Provider business mailing address

1645 W OGDEN AVE UNIT 641
CHICAGO IL
60612-4386
US

V. Phone/Fax

Practice location:
  • Phone: 773-579-0832
  • Fax:
Mailing address:
  • Phone: 312-918-7640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.015810
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: