Provider Demographics
NPI:1558883322
Name:LOZANO, MICHELLE CHRISTINE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CHRISTINE
Last Name:LOZANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 S WESTERN AVENUE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2503
Mailing Address - Country:US
Mailing Address - Phone:773-584-6200
Mailing Address - Fax:844-285-1003
Practice Address - Street 1:4700 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-2016
Practice Address - Country:US
Practice Address - Phone:773-584-6200
Practice Address - Fax:844-285-1003
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166001415106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist