Healthcare Provider Details

I. General information

NPI: 1659951093
Provider Name (Legal Business Name): CLARE MAZURKIEWICZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 04/09/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PYOTT RD STE 208A
LAKE IN THE HILLS IL
60156-9798
US

IV. Provider business mailing address

1301 PYOTT RD STE 208A
LAKE IN THE HILLS IL
60156-9798
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-7890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.013746
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number18-372
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: