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General NPI Number Information
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NPI Number | 1093232134
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Entity Type | Individual
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Provider Name | ROBERT EDWARD PROHASKA LPC
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Gender | Male
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 08/29/2017
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Provider Practice Location Address
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Address Line | 911 N ELM ST STE 316
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City | HINSDALE
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State | IL
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Zip | 60521-3642
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Country | US
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Telephone | 163-065-5040
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Fax |
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Provider Business Mailing Address
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Address Line | 12032 S 70TH AVE
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1503
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178013095
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License Number State | IL
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