Provider Demographics
NPI:1639688641
Name:NICOLE LARUCCI, LTD
Entity Type:Organization
Organization Name:NICOLE LARUCCI, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MA LCPC
Authorized Official - Phone:630-338-3696
Mailing Address - Street 1:208 S EMERALD DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60051-3309
Mailing Address - Country:US
Mailing Address - Phone:630-338-3696
Mailing Address - Fax:
Practice Address - Street 1:1301 PYOTT RD STE 201E
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-9797
Practice Address - Country:US
Practice Address - Phone:224-703-6504
Practice Address - Fax:224-678-9652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008684101YM0800X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty