Provider Demographics
NPI:1649390675
Name:MUNOZ, JESSE L (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:L
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JESUS
Other - Middle Name:L
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:14534 S EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60827-2619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14400 JOHN HUMPHREY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2897
Practice Address - Country:US
Practice Address - Phone:708-226-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health