Healthcare Provider Details

I. General information

NPI: 1548446339
Provider Name (Legal Business Name): RON JOSEPH CZUB LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 COUNTRY LN
LEMONT IL
60439-4199
US

IV. Provider business mailing address

1212 COUNTRY LN
LEMONT IL
60439-4199
US

V. Phone/Fax

Practice location:
  • Phone: 708-305-0458
  • Fax:
Mailing address:
  • Phone: 708-305-0458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number108.004298
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.004298
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: