Provider Demographics
NPI:1275007486
Name:CICUREL, TERI
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:CICUREL
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 1:9 W WALTON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7324
Mailing Address - Country:US
Mailing Address - Phone:773-230-2025
Mailing Address - Fax:
Practice Address - Street 1:25 E WASHINGTON ST STE 1458
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1856
Practice Address - Country:US
Practice Address - Phone:312-476-9159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.01.4275101YP2500X
IL180.013386101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional