Healthcare Provider Details

I. General information

NPI: 1285085589
Provider Name (Legal Business Name): JAIMEE JAUCIAN MA, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 MAIN ST
MELROSE PARK IL
60160-3902
US

IV. Provider business mailing address

2736 W CORTLAND ST APT 1R
CHICAGO IL
60647-6625
US

V. Phone/Fax

Practice location:
  • Phone: 708-338-3806
  • Fax: 708-681-1289
Mailing address:
  • Phone: 312-715-4396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.008605
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: