Provider Demographics
NPI:1629200795
Name:ALONSO, JAVIER STEVEN (LPC, CADC)
Entity Type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:STEVEN
Last Name:ALONSO
Suffix:
Gender:M
Credentials:LPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3545 LAKE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1058
Mailing Address - Country:US
Mailing Address - Phone:847-251-7350
Mailing Address - Fax:847-853-2600
Practice Address - Street 1:3545 LAKE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1058
Practice Address - Country:US
Practice Address - Phone:847-251-7350
Practice Address - Fax:847-853-2600
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL24817101YA0400X
IL178.004157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional