Provider Demographics
NPI:1467073163
Name:SEGAL, EMILY RACHEL (ATR, LCPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:RACHEL
Last Name:SEGAL
Suffix:
Gender:F
Credentials:ATR, LCPC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:RACHEL
Other - Last Name:SEGAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATR, LCPC
Mailing Address - Street 1:2037 W MORSE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-4984
Mailing Address - Country:US
Mailing Address - Phone:847-404-5747
Mailing Address - Fax:
Practice Address - Street 1:500 BROWN BLVD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2328
Practice Address - Country:US
Practice Address - Phone:815-214-9766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17-244221700000X
IL180.011549101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist