Provider Demographics
NPI:1043976111
Name:BURLINGAME, NICOLE L (LPC, LMHCA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:BURLINGAME
Suffix:
Gender:F
Credentials:LPC, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0S438 MELOLANE RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-3735
Mailing Address - Country:US
Mailing Address - Phone:847-347-7812
Mailing Address - Fax:
Practice Address - Street 1:0S438 MELOLANE RD
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-3735
Practice Address - Country:US
Practice Address - Phone:847-347-7812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.016786101YP2500X
WAMC61324701101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional