Healthcare Provider Details

I. General information

NPI: 1518908201
Provider Name (Legal Business Name): SUSAN A CUEVAS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 WINDHAM PKWY
ROMEOVILLE IL
60446-1608
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-0264
US

V. Phone/Fax

Practice location:
  • Phone: 815-942-6323
  • Fax: 779-210-5541
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180005562
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: