Healthcare Provider Details

I. General information

NPI: 1457264954
Provider Name (Legal Business Name): MATHURAM (MADHU) CHIDAMBARAM BALASUBRAMANIAM LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26W401 GENEVA RD
WHEATON IL
60187-2235
US

IV. Provider business mailing address

26W401 GENEVA RD
WHEATON IL
60187-2235
US

V. Phone/Fax

Practice location:
  • Phone: 630-945-7541
  • Fax:
Mailing address:
  • Phone: 630-945-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.018810
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: