Healthcare Provider Details

I. General information

NPI: 1134880701
Provider Name (Legal Business Name): ROY W CARNEY LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 N OAK PARK AVE STE 212
OAK PARK IL
60301-1340
US

IV. Provider business mailing address

137 N OAK PARK AVE STE 212
OAK PARK IL
60301-1340
US

V. Phone/Fax

Practice location:
  • Phone: 773-391-2865
  • Fax:
Mailing address:
  • Phone: 773-391-2865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.013690
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: