Provider Demographics
NPI:1508201328
Name:SCHREIBER, TERA KATHLEEN (LCPC)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:KATHLEEN
Last Name:SCHREIBER
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 1:2324 W ADDISON ST
Mailing Address - Street 2:APT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6018
Mailing Address - Country:US
Mailing Address - Phone:773-430-3695
Mailing Address - Fax:
Practice Address - Street 1:484 LEE ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4610
Practice Address - Country:US
Practice Address - Phone:773-368-8552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007927101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional