Provider Demographics
NPI:1134478142
Name:BAK, ALANA MIRELLE (LCPC)
Entity Type:Individual
Prefix:
First Name:ALANA
Middle Name:MIRELLE
Last Name:BAK
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 1:1950 HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-6846
Mailing Address - Country:US
Mailing Address - Phone:773-270-1555
Mailing Address - Fax:
Practice Address - Street 1:1950 HANCOCK DR
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-6846
Practice Address - Country:US
Practice Address - Phone:773-270-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty