Provider Demographics
NPI:1710242532
Name:O'DEA, CLAIRISSA M (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:CLAIRISSA
Middle Name:M
Last Name:O'DEA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 DUNBAR RD
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1167
Mailing Address - Country:US
Mailing Address - Phone:847-920-4325
Mailing Address - Fax:
Practice Address - Street 1:505 E HAWLEY ST
Practice Address - Street 2:SUITE 140
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-2494
Practice Address - Country:US
Practice Address - Phone:847-920-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.006898101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health