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General NPI Number Information
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NPI Number | 1245768647
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Entity Type | Individual
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Provider Name | MICHAEL CONNELL MA, LMFT
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Gender | Male
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Dates
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Enumeration Date | 05/30/2017
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 3375 COMMERCIAL AVE STE 10
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City | NORTHBROOK
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State | IL
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Zip | 60062-1908
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Country | US
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Telephone | 312-438-8654
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Fax |
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Provider Business Mailing Address
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Address Line | 4732 N AUSTIN AVE UNIT 405
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City | CHICAGO
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State | IL
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Zip | 60630-3796
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Country | US
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Telephone | 847-921-0921
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 106001254
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 208000367
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License Number State | IL
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