Provider Demographics
NPI:1710091582
Name:DEVRIES, LOUELLA BETH (LCPC)
Entity Type:Individual
Prefix:
First Name:LOUELLA
Middle Name:BETH
Last Name:DEVRIES
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 1:15601 CICERO AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-3636
Mailing Address - Country:US
Mailing Address - Phone:708-687-3479
Mailing Address - Fax:708-687-3480
Practice Address - Street 1:15601 CICERO AVE STE 103
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-3636
Practice Address - Country:US
Practice Address - Phone:708-687-3479
Practice Address - Fax:708-687-3480
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
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