Individual provider · Type 1 NPI
Mary Theis, MA, CSLG PSY LCPC
Professional Counselor · Evanston, IL
NPI number
1366808974
Active
Practice location
9343 Drake Ave
Evanston, IL 60203-1406
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Professional Counselor Primary | 101YP2500X | 180.004853 (IL) |
Professional Counselor: Definition to come...
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About NPI 1366808974
Mary Theis, MA, CSLG PSY LCPC's National Provider Identifier is 1366808974, issued on Jan 12, 2016. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Evanston, IL. The record was last updated on Jan 12, 2016.