Provider Demographics
NPI:1568695385
Name:DERHODES, DOUGLAS K (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:K
Last Name:DERHODES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5351 N ASHLAND AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2053
Mailing Address - Country:US
Mailing Address - Phone:773-896-5876
Mailing Address - Fax:708-300-9491
Practice Address - Street 1:822 HILLGROVE AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1464
Practice Address - Country:US
Practice Address - Phone:773-969-6864
Practice Address - Fax:708-300-9491
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0134001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical