Healthcare Provider Details

I. General information

NPI: 1528784543
Provider Name (Legal Business Name): MAIRA ANNE EGAN LPC, ATR-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 W NORTH AVE STE 402
CHICAGO IL
60622-0204
US

IV. Provider business mailing address

2611 N ALBANY AVE APT 2
CHICAGO IL
60647-1667
US

V. Phone/Fax

Practice location:
  • Phone: 312-819-7381
  • Fax:
Mailing address:
  • Phone: 773-865-4193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.021294
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: