Provider Demographics
NPI:1679875884
Name:DALEY, MARY ELIZABETH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:DALEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:HANLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:505 E HAWLEY ST STE 140
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-2458
Mailing Address - Country:US
Mailing Address - Phone:847-347-7667
Mailing Address - Fax:224-513-4700
Practice Address - Street 1:505 E HAWLEY ST STE 140
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-2458
Practice Address - Country:US
Practice Address - Phone:847-347-7667
Practice Address - Fax:224-513-4700
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178003357101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178003357OtherLICENSED PROFESSIONAL COUNSELOR