Provider Demographics
NPI:1083850473
Name:CIESIL, BRUCE (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:CIESIL
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S WILKE RD
Mailing Address - Street 2:SUITE 203 C
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1534
Mailing Address - Country:US
Mailing Address - Phone:630-205-1926
Mailing Address - Fax:847-952-9722
Practice Address - Street 1:125 S WILKE RD
Practice Address - Street 2:SUITE 203 C
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1534
Practice Address - Country:US
Practice Address - Phone:630-205-1926
Practice Address - Fax:847-952-9722
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health