Provider Demographics
NPI:1205389087
Name:CHRISTINE T BELLOSA MA LCPC INCORPORATED
Entity Type:Organization
Organization Name:CHRISTINE T BELLOSA MA LCPC INCORPORATED
Other - Org Name:BELLOSA COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINEE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BELLOSA
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-420-8597
Mailing Address - Street 1:7730 W JEROME ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-4226
Mailing Address - Country:US
Mailing Address - Phone:312-420-8597
Mailing Address - Fax:
Practice Address - Street 1:350 S NORTHWEST HWY
Practice Address - Street 2:STE 300
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4216
Practice Address - Country:US
Practice Address - Phone:847-656-5259
Practice Address - Fax:847-656-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007252101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty