Provider Demographics
NPI:1518362854
Name:PELAEZ, SARA K (MA, LCPC, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:K
Last Name:PELAEZ
Suffix:
Gender:F
Credentials:MA, LCPC, LPC, NCC
Other - Prefix:
Other - First Name:SARITA
Other - Middle Name:K
Other - Last Name:PELAEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LCPC, LPC, NCC
Mailing Address - Street 1:242 CIMARRON RD W
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-1446
Mailing Address - Country:US
Mailing Address - Phone:630-640-2192
Mailing Address - Fax:
Practice Address - Street 1:242 CIMARRON RD W
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-1446
Practice Address - Country:US
Practice Address - Phone:630-640-2192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010685101YP2500X
IL17810278101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional