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General NPI Number Information
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NPI Number | 1619328341
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Entity Type | Individual
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Provider Name | TERESA MARKUM LCPC
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Gender | Female
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 4300 COMMERCE CT SUITE 300
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City | LISLE
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State | IL
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Zip | 60532-3709
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Country | US
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Telephone | 309-258-8851
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Fax | 872-228-8139
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Provider Business Mailing Address
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Address Line | 5824 WALNUT AVE APT 2C
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-6015
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Country | US
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Telephone | 309-258-8851
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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 | 180010256
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License Number State | IL
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