Provider Demographics
NPI:1235229154
Name:RICELY, JANIS IRIS (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JANIS
Middle Name:IRIS
Last Name:RICELY
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:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60138-0346
Mailing Address - Country:US
Mailing Address - Phone:630-545-5132
Mailing Address - Fax:630-539-1094
Practice Address - Street 1:610 W ROOSEVELT RD # D
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5087
Practice Address - Country:US
Practice Address - Phone:630-881-7466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health