Provider Demographics
NPI:1750464483
Name:HERATY, MARY F (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:F
Last Name:HERATY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:P
Other - Last Name:HERATY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:101 N VIRGINIA ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014
Mailing Address - Country:US
Mailing Address - Phone:815-823-2299
Mailing Address - Fax:815-301-9914
Practice Address - Street 1:101 N VIRGINIA ST
Practice Address - Street 2:SUITE 190
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014
Practice Address - Country:US
Practice Address - Phone:815-823-2299
Practice Address - Fax:815-301-9914
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional