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General NPI Number Information
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NPI Number | 1639666746
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Entity Type | Individual
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Provider Name | BRAD JEFFEREY NOVAK MA, LCPC
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Gender | Male
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Dates
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Enumeration Date | 04/16/2018
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Last Update Date | 04/16/2018
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Provider Practice Location Address
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Address Line | 333 N MICHIGAN AVE STE 1900
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City | CHICAGO
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State | IL
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Zip | 60601-3994
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Country | US
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Telephone | 773-321-2768
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Fax | 312-540-0944
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Provider Business Mailing Address
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Address Line | 333 N MICHIGAN AVE STE 1900
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City | CHICAGO
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State | IL
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Zip | 60601-3994
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Country | US
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Telephone | 773-321-2768
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Fax | 312-540-0944
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180.011567
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License Number State | IL
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