Provider Demographics
NPI:1467153502
Name:MIAN, AYLA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AYLA
Middle Name:
Last Name:MIAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HIDDEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-8371
Mailing Address - Country:US
Mailing Address - Phone:630-863-6147
Mailing Address - Fax:
Practice Address - Street 1:2000 N RACINE AVE STE 2040
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7006
Practice Address - Country:US
Practice Address - Phone:630-863-6147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017276101YP2500X
178.017276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional