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General NPI Number Information
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NPI Number | 1689864126
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Entity Type | Individual
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Provider Name | RAPHAEL A JUSS EDD
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Gender | Male
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 07/31/2007
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Provider Practice Location Address
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Address Line | 1300 N LAKE SHORE DRIVE SUITE 13D
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City | CHICAGO
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State | IL
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Zip | 60610-2193
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Country | US
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Telephone | 312-642-7785
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 N LAKE SHORE DRIVE SUITE 13D
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City | CHICAGO
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State | IL
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Zip | 60610-2193
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Country | US
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Telephone | 312-642-7785
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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 | LPC 365
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 10580
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 969747
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 1233025
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License Number State |
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMT 145
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License Number State | TN
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Taxonomy #6
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | IL
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