Healthcare Provider Details

I. General information

NPI: 1316751894
Provider Name (Legal Business Name): MARC ANTHONY CUIRIZ MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 N LARKIN AVE STE 205
JOLIET IL
60435-3440
US

IV. Provider business mailing address

14513 SAMUEL ADAMS DR
PLAINFIELD IL
60544-4433
US

V. Phone/Fax

Practice location:
  • Phone: 708-789-5669
  • Fax:
Mailing address:
  • Phone: 630-270-9602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: