Provider Demographics
NPI:1164175816
Name:SEXTON, GRACE ELLEN (LPC, ATR-P)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ELLEN
Last Name:SEXTON
Suffix:
Gender:F
Credentials:LPC, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 SOUTH BLVD APT 715
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-3285
Mailing Address - Country:US
Mailing Address - Phone:660-988-0973
Mailing Address - Fax:
Practice Address - Street 1:2804 W BELMONT AVE STE 103
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5879
Practice Address - Country:US
Practice Address - Phone:224-504-9854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017110101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1205286440OtherBUSINESS NPI NUMBER