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General NPI Number Information
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NPI Number | 1891025995
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Entity Type | Organization
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Legal Business Name | LORI MAREK-MCKILLOP
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 3501 MAPLE AVE
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City | BROOKFIELD
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State | IL
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Zip | 60513-1249
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Country | US
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Telephone | 708-309-0915
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Fax |
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Provider Business Mailing Address
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Address Line | 3501 MAPLE AVE
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City | BROOKFIELD
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State | IL
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Zip | 60513-1249
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Country | US
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Telephone | 708-309-0915
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. LORI MAREK-MCKILLOP
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Credential | M.S., L.C.P.C.
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Telephone | 708-309-0915
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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 | 180.006796
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 180.006796
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.006796
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License Number State | IL
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