Healthcare Provider Details

I. General information

NPI: 1447623970
Provider Name (Legal Business Name): KATRINA NEUBAUER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 11/17/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 W WAVERLY ST
MORRIS IL
60450-1334
US

IV. Provider business mailing address

13136 WESTERN AVE
BLUE ISLAND IL
60406-2423
US

V. Phone/Fax

Practice location:
  • Phone: 815-941-0441
  • Fax:
Mailing address:
  • Phone: 708-974-5800
  • Fax: 708-371-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180010675
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: