Provider Demographics
NPI:1124182308
Name:AMMIRATI, TERESA (LCPC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:AMMIRATI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9344 LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60203-1305
Mailing Address - Country:US
Mailing Address - Phone:847-217-9381
Mailing Address - Fax:847-673-9507
Practice Address - Street 1:210 W 22ND ST
Practice Address - Street 2:SUITE 118
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1544
Practice Address - Country:US
Practice Address - Phone:847-217-9381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1189017655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232062OtherBC AND BS IL