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General NPI Number Information
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NPI Number | 1275007486
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Entity Type | Individual
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Provider Name | TERI CICUREL
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Gender | Female
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 25 E WASHINGTON ST STE 1458
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City | CHICAGO
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State | IL
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Zip | 60602-1856
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Country | US
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Telephone | 312-476-9159
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Fax |
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Provider Business Mailing Address
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Address Line | 9 W WALTON ST
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City | CHICAGO
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State | IL
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Zip | 60610-7324
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Country | US
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Telephone | 773-230-2025
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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 | 178.01.4275
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180.013386
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License Number State | IL
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