Healthcare Provider Details

I. General information

NPI: 1659438430
Provider Name (Legal Business Name): MAUREEN PATRICE TAMILLOW LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W CHICAGO AVE
HINSDALE IL
60521-3356
US

IV. Provider business mailing address

1145 S SCOVILLE AVE
OAK PARK IL
60304-2129
US

V. Phone/Fax

Practice location:
  • Phone: 630-655-9040
  • Fax:
Mailing address:
  • Phone: 708-386-1742
  • Fax: 708-386-4217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-001057
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180-001057
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number2186312
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25778
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: