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General NPI Number Information
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NPI Number | 1912397316
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Entity Type | Individual
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Provider Name | BRIAN TRUNCALE SR. LCPC
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Gender | Male
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Dates
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Enumeration Date | 01/23/2015
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 4009 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60613-2110
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Country | US
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Telephone | 773-275-2586
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Fax |
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Provider Business Mailing Address
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Address Line | 1338 W ARGYLE ST 1N
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City | CHICAGO
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State | IL
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Zip | 60640-3564
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Country | US
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Telephone | 773-240-9910
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Fax | 773-243-0058
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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 | 180006450
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License Number State | IL
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