Healthcare Provider Details

I. General information

NPI: 1457680795
Provider Name (Legal Business Name): RAQUEL GALAN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 CHICAGO AVENUE SUITE 10
EVANSTON IL
60201
US

IV. Provider business mailing address

1604 CHICAGO AVENUE SUITE 10
EVANSTON IL
60201
US

V. Phone/Fax

Practice location:
  • Phone: 773-599-2387
  • Fax:
Mailing address:
  • Phone: 773-599-2387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number180.011552
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.011552
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2187138
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.011552
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: