Provider Demographics
NPI:1689394611
Name:KAPETAN, JOHN JAMES (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JAMES
Last Name:KAPETAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 W TOUHY AVE APT 503
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4390
Mailing Address - Country:US
Mailing Address - Phone:847-668-4869
Mailing Address - Fax:847-728-5313
Practice Address - Street 1:120 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4044
Practice Address - Country:US
Practice Address - Phone:847-668-4869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178008543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty