Healthcare Provider Details

I. General information

NPI: 1730544248
Provider Name (Legal Business Name): GEORGE ANTHONY TOTLEBEN JR. LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4471 LAWN AVE STE 202
WESTERN SPRINGS IL
60558-1765
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-7890
  • Fax:
Mailing address:
  • Phone: 630-428-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180009580
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: