Provider Demographics
NPI:1407968076
Name:THELEN, CYNTHIA LEE (LCPC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LEE
Last Name:THELEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:THELEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:1010 JORIE BLVD STE 364
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-3000
Mailing Address - Country:US
Mailing Address - Phone:630-530-0405
Mailing Address - Fax:630-530-0405
Practice Address - Street 1:1010 JORIE BLVD STE 364
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-3000
Practice Address - Country:US
Practice Address - Phone:630-530-0405
Practice Address - Fax:630-530-0405
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005530101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional