Provider Demographics
NPI:1275716136
Name:LISA MEDANIC COUNSELING, LTD.
Entity Type:Organization
Organization Name:LISA MEDANIC COUNSELING, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEDANIC
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:630-393-4019
Mailing Address - Street 1:3126 CRYSTAL ROCK RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8241
Mailing Address - Country:US
Mailing Address - Phone:630-393-4019
Mailing Address - Fax:630-904-9871
Practice Address - Street 1:29W120 BUTTERFIELD RD STE 104A
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-2830
Practice Address - Country:US
Practice Address - Phone:630-393-4019
Practice Address - Fax:630-904-9871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty