Healthcare Provider Details

I. General information

NPI: 1558118216
Provider Name (Legal Business Name): ANDREW ROBERT TOWNSEND CT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 MAIN ST
MELROSE PARK IL
60160-3902
US

IV. Provider business mailing address

120 E OAK ST
VILLA PARK IL
60181-2113
US

V. Phone/Fax

Practice location:
  • Phone: 708-681-0073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.022167
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: