Healthcare Provider Details

I. General information

NPI: 1164823449
Provider Name (Legal Business Name): CLARE OKUBO LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 11/29/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 CLEVELAND ST
EVANSTON IL
60202-1912
US

IV. Provider business mailing address

2024 CLEVELAND ST
EVANSTON IL
60202-1912
US

V. Phone/Fax

Practice location:
  • Phone: 773-474-9612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.010157
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.010157
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.010157
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.010914
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: