Provider Demographics
NPI:1518507516
Name:URBINA, OCTAVIO
Entity Type:Individual
Prefix:
First Name:OCTAVIO
Middle Name:
Last Name:URBINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:IL
Mailing Address - Zip Code:60534-1126
Mailing Address - Country:US
Mailing Address - Phone:773-255-9414
Mailing Address - Fax:
Practice Address - Street 1:8110 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:IL
Practice Address - Zip Code:60534-1126
Practice Address - Country:US
Practice Address - Phone:773-255-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool