Provider Demographics
NPI:1629476254
Name:WEIR, COREY WILLIAM (LCPC)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:WILLIAM
Last Name:WEIR
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E ROOSEVELT RD STE 203
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1256 WATERFORD DR
Practice Address - Street 2:#140
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4510
Practice Address - Country:US
Practice Address - Phone:630-898-5322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-14
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009231101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional