Provider Demographics
NPI:1710024187
Name:MEYER KLARICH, NICOLE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:MEYER KLARICH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N ARTESIAN AVE
Mailing Address - Street 2:UNIT 1E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5311
Mailing Address - Country:US
Mailing Address - Phone:773-524-2685
Mailing Address - Fax:
Practice Address - Street 1:2302 W NORTH AVE
Practice Address - Street 2:SUITE 1E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6260
Practice Address - Country:US
Practice Address - Phone:773-524-2685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635596OtherBCBS PROVIDER NUMBER