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General NPI Number Information
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NPI Number | 1811063621
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Entity Type | Individual
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Provider Name | ROGER MRAZEK LCPC,CADC,CEAP
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Gender | Male
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2445 W 112TH ST CHICAGO
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City | CHICAGO
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State | IL
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Zip | 60655-1351
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Country | US
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Telephone | 773-879-8696
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Fax |
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Provider Business Mailing Address
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Address Line | 1335 S. PRAIRIE AVE. #1503 CHICAGO
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City | CHICAGO
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State | IL
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Zip | 60605-3138
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Country | US
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Telephone |
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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 | 180000808
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License Number State | IL
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