Healthcare Provider Details

I. General information

NPI: 1699980870
Provider Name (Legal Business Name): BRIAN KATZ LCPC, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S MAIN ST
LOMBARD IL
60148-5334
US

IV. Provider business mailing address

71 WHISPERING DR
STREAMWOOD IL
60107-2304
US

V. Phone/Fax

Practice location:
  • Phone: 630-643-3181
  • Fax:
Mailing address:
  • Phone: 630-643-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25848
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.008192
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: