Provider Demographics
NPI:1558407403
Name:CRICK, MARY (MSW, CSADC, MATTP,)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CRICK
Suffix:
Gender:F
Credentials:MSW, CSADC, MATTP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 PHEASANT TRL
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-1357
Mailing Address - Country:US
Mailing Address - Phone:847-791-4384
Mailing Address - Fax:847-426-5384
Practice Address - Street 1:783 S 8TH ST
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2108
Practice Address - Country:US
Practice Address - Phone:847-791-4384
Practice Address - Fax:847-426-5384
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-5029-0002-A101YA0400X
IL12267101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)