Provider Demographics
NPI:1639628654
Name:ABDULLAH, JAHAAN (LPC)
Entity Type:Individual
Prefix:
First Name:JAHAAN
Middle Name:
Last Name:ABDULLAH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 BETHANY RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3126
Mailing Address - Country:US
Mailing Address - Phone:815-264-2154
Mailing Address - Fax:815-264-2315
Practice Address - Street 1:2535 BETHANY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3126
Practice Address - Country:US
Practice Address - Phone:815-264-2154
Practice Address - Fax:815-264-2315
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.010738101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178.010738OtherILLINOIS COUNSELING LICENSE