Provider Demographics
NPI:1619328341
Name:MARKUM, TERESA (LCPC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:MARKUM
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 WALNUT AVE
Mailing Address - Street 2:APT 2C
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-6015
Mailing Address - Country:US
Mailing Address - Phone:309-258-8851
Mailing Address - Fax:
Practice Address - Street 1:4300 COMMERCE CT
Practice Address - Street 2:SUITE 300
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3709
Practice Address - Country:US
Practice Address - Phone:309-258-8851
Practice Address - Fax:872-228-8139
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional