Provider Demographics
NPI:1740603554
Name:MIHAILOVIC, MARKO (LPC)
Entity Type:Individual
Prefix:MR
First Name:MARKO
Middle Name:
Last Name:MIHAILOVIC
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 1:77 W WASHINGTON ST
Mailing Address - Street 2:SUITE # 1601
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2801
Mailing Address - Country:US
Mailing Address - Phone:773-816-4228
Mailing Address - Fax:
Practice Address - Street 1:4250 N MARINE DR
Practice Address - Street 2:APT # 1633
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1744
Practice Address - Country:US
Practice Address - Phone:773-816-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.009151101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional