Provider Demographics
NPI:1558650382
Name:TOOSI, MANDANA (MA)
Entity Type:Individual
Prefix:
First Name:MANDANA
Middle Name:
Last Name:TOOSI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1005
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2826
Mailing Address - Country:US
Mailing Address - Phone:312-809-7036
Mailing Address - Fax:
Practice Address - Street 1:3923 MERCY DR
Practice Address - Street 2:SUITE F
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-3173
Practice Address - Country:US
Practice Address - Phone:815-344-5061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health