Provider Demographics
NPI:1073804829
Name:ORNELAS, RAQUEL A (LPC)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:A
Last Name:ORNELAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9916 S CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4001
Mailing Address - Country:US
Mailing Address - Phone:708-256-4675
Mailing Address - Fax:
Practice Address - Street 1:9916 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4001
Practice Address - Country:US
Practice Address - Phone:708-256-4675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.006497101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor