Provider Demographics
NPI:1558034041
Name:NIELSEN, CYNTHIA (LPC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 N LAKE SHORE DR APT 3405
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5315
Mailing Address - Country:US
Mailing Address - Phone:847-624-1582
Mailing Address - Fax:
Practice Address - Street 1:3660 N LAKE SHORE DR APT 3405
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5315
Practice Address - Country:US
Practice Address - Phone:847-624-1582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.016685103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling