Provider Demographics
NPI:1497035224
Name:CONNELLY, JOEL MARC (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:MARC
Last Name:CONNELLY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6006 E LAKE DR
Mailing Address - Street 2:#3D
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3049
Mailing Address - Country:US
Mailing Address - Phone:630-561-1177
Mailing Address - Fax:
Practice Address - Street 1:1263 S HIGHLAND AVE
Practice Address - Street 2:2D
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4516
Practice Address - Country:US
Practice Address - Phone:630-290-7762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178007529101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional