Provider Demographics
NPI:1790231538
Name:NUNEZ, TANIA E (LCPC)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:E
Last Name:NUNEZ
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 1:4952 W ROSCOE ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4337
Mailing Address - Country:US
Mailing Address - Phone:773-954-3030
Mailing Address - Fax:
Practice Address - Street 1:4952 W ROSCOE ST UNIT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4337
Practice Address - Country:US
Practice Address - Phone:773-954-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.013120101YP2500X
IL178.010899101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional