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General NPI Number Information
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NPI Number | 1740603554
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Entity Type | Individual
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Provider Name | MARKO MIHAILOVIC LPC
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Gender | Male
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 4250 N MARINE DR APT # 1633
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City | CHICAGO
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State | IL
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Zip | 60613-1744
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Country | US
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Telephone | 773-816-4228
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Fax |
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Provider Business Mailing Address
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Address Line | 77 W WASHINGTON ST SUITE # 1601
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City | CHICAGO
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State | IL
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Zip | 60602-2801
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Country | US
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Telephone | 773-816-4228
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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 | 178.009151
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License Number State | IL
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