Provider Demographics
NPI:1477652873
Name:VANHEEST, MARY L (LCPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:VANHEEST
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5970
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-5312
Mailing Address - Country:US
Mailing Address - Phone:630-424-0652
Mailing Address - Fax:
Practice Address - Street 1:2803 BUTTERFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1165
Practice Address - Country:US
Practice Address - Phone:630-424-0652
Practice Address - Fax:847-424-4783
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004857101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional