Healthcare Provider Details

I. General information

NPI: 1134057359
Provider Name (Legal Business Name): MICHELLE NORA BRENNAN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16860 OAK PARK AVE STE 103
TINLEY PARK IL
60477-2008
US

IV. Provider business mailing address

3148 BUTLER AVE
STEGER IL
60475-1141
US

V. Phone/Fax

Practice location:
  • Phone: 708-305-5226
  • Fax:
Mailing address:
  • Phone: 708-305-5226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.018212
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: