Provider Demographics
NPI:1407195571
Name:ABOUREZK, ILYANI LENA (MS, LPCMH, QMHP NCC)
Entity Type:Individual
Prefix:
First Name:ILYANI
Middle Name:LENA
Last Name:ABOUREZK
Suffix:
Gender:F
Credentials:MS, LPCMH, QMHP NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W OMAHA ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8061
Mailing Address - Country:US
Mailing Address - Phone:605-863-2881
Mailing Address - Fax:605-342-5170
Practice Address - Street 1:2020 W OMAHA ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8061
Practice Address - Country:US
Practice Address - Phone:605-863-2881
Practice Address - Fax:605-342-5170
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPCMH2276101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health