Healthcare Provider Details

I. General information

NPI: 1174346779
Provider Name (Legal Business Name): HAILEY TOKARSYCK MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 MCDOWELL RD #305
NAPERVILLE IL
60563
US

IV. Provider business mailing address

2457 W GUNNISON ST APT 1
CHICAGO IL
60625-2896
US

V. Phone/Fax

Practice location:
  • Phone: 630-689-1022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.020702
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: