Healthcare Provider Details

I. General information

NPI: 1649547936
Provider Name (Legal Business Name): MARTIN BEIRNE LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 03/25/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 N MILL ST STE 100
NAPERVILLE IL
60563-2047
US

IV. Provider business mailing address

1335 N MILL ST STE 100
NAPERVILLE IL
60563-2047
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-8000
  • Fax:
Mailing address:
  • Phone: 630-646-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.004189
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: