Provider Demographics
NPI:1659383826
Name:JANA, EDWARD CHARLES (LCPC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:CHARLES
Last Name:JANA
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 1:467 LONGCOMMON RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1706
Mailing Address - Country:US
Mailing Address - Phone:708-447-1965
Mailing Address - Fax:
Practice Address - Street 1:3239 GROVE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3468
Practice Address - Country:US
Practice Address - Phone:708-447-1965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-000658101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional