Provider Demographics
NPI:1164536173
Name:CUNNINGHAM, PATRICK J (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 JORIE BLVD
Mailing Address - Street 2:SUITE 366
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2215
Mailing Address - Country:US
Mailing Address - Phone:630-561-3422
Mailing Address - Fax:866-372-1624
Practice Address - Street 1:1010 JORIE BLVD
Practice Address - Street 2:SUITE 366
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2215
Practice Address - Country:US
Practice Address - Phone:630-561-3422
Practice Address - Fax:866-372-1624
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL180-004499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002232229OtherBLUE CROSS BLUE SHIELD