Healthcare Provider Details

I. General information

NPI: 1942829833
Provider Name (Legal Business Name): HEATHER A AVILES MA ATR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2020
Last Update Date: 04/11/2020
Certification Date: 04/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S WASHINGTON ST
NAPERVILLE IL
60540-6749
US

IV. Provider business mailing address

525 S WASHINGTON ST
NAPERVILLE IL
60540-6749
US

V. Phone/Fax

Practice location:
  • Phone: 630-697-9300
  • Fax:
Mailing address:
  • Phone: 630-637-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.0070637612109
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number12-115
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: