Provider Demographics
NPI:1154083491
Name:LI, XUE
Entity Type:Individual
Prefix:
First Name:XUE
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 N HARLEM AVE APT 1025
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-6414
Mailing Address - Country:US
Mailing Address - Phone:602-317-9196
Mailing Address - Fax:
Practice Address - Street 1:10035 GRAND AVE FL 3
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-2500
Practice Address - Country:US
Practice Address - Phone:708-688-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor