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General NPI Number Information
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NPI Number | 1740403476
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Entity Type | Organization
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Legal Business Name | DR. MARTIE RYAN LUKANICH
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9601 165TH ST SUITE 6
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City | ORLAND PARK
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State | IL
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Zip | 60467-5660
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Country | US
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Telephone | 708-829-8277
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Fax | 708-352-2305
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Provider Business Mailing Address
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Address Line | 9601 165TH ST SUITE 6
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City | ORLAND PARK
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State | IL
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Zip | 60467-5660
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Country | US
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Telephone | 708-829-8277
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Fax | 708-352-2305
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR
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Name | DR. MARTIE RYAN LUKANICH
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Credential | PSY.D.,LCPC
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Telephone | 708-829-8277
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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 |
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License Number State | IL
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