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General NPI Number Information
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NPI Number | 1619641610
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Entity Type | Individual
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Provider Name | RYAN ACEVEZ LCPC
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Gender | Male
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 10225 GRAND AVE
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City | FRANKLIN PARK
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State | IL
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Zip | 60131-3138
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Country | US
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Telephone | 844-599-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 373 SUMMIT ST
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City | ELGIN
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State | IL
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Zip | 60120-3733
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Country | US
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Telephone | 844-599-3700
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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 | 180.010465
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License Number State | IL
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