Provider Demographics
NPI:1053651083
Name:ABBED, ALYA (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:ALYA
Middle Name:
Last Name:ABBED
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:ALYA
Other - Middle Name:KAZAK
Other - Last Name:ABBED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LCPC
Mailing Address - Street 1:3121 RIDGE CREST DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-8307
Mailing Address - Country:US
Mailing Address - Phone:309-287-3583
Mailing Address - Fax:
Practice Address - Street 1:706 OGLESBY AVE STE 114A
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4616
Practice Address - Country:US
Practice Address - Phone:309-807-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health