Healthcare Provider Details

I. General information

NPI: 1760774509
Provider Name (Legal Business Name): PREMLATA NIKONIUK LPC, LCPC, CCMHC CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1291 BRADLEY CIR
ELGIN IL
60120-2399
US

IV. Provider business mailing address

1291 BRADLEY CIR
ELGIN IL
60120-2399
US

V. Phone/Fax

Practice location:
  • Phone: 630-335-3060
  • Fax:
Mailing address:
  • Phone: 630-335-3060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number143831
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0024694
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0680137399TELE
License Number StateVT
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180007642
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberTPMC4989
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: