Healthcare Provider Details

I. General information

NPI: 1629787148
Provider Name (Legal Business Name): ARACELY HERNANDEZ MA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARACELY DE LA LUZ LANDA

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/23/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SKOKIE BLVD STE 255
NORTHBROOK IL
60062-4054
US

IV. Provider business mailing address

900 SKOKIE BLVD STE 255
NORTHBROOK IL
60062-4054
US

V. Phone/Fax

Practice location:
  • Phone: 312-870-0120
  • Fax: 312-819-2080
Mailing address:
  • Phone: 312-870-0120
  • Fax: 312-819-2080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: