Healthcare Provider Details

I. General information

NPI: 1982970471
Provider Name (Legal Business Name): CAITLIN M RYAN LCPC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15127 S 73RD AVE STE C
ORLAND PARK IL
60462-4398
US

IV. Provider business mailing address

15127 S 73RD AVE STE C
ORLAND PARK IL
60462-4398
US

V. Phone/Fax

Practice location:
  • Phone: 708-586-9303
  • Fax: 866-950-9427
Mailing address:
  • Phone: 708-586-9303
  • Fax: 866-950-9427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.007109
License Number StateIL

VIII. Authorized Official

Name: CAITLIN RYAN
Title or Position: LCPC
Credential: LCPC
Phone: 708-586-9303