Provider Demographics
NPI:1821564998
Name:DE FREITAS, CHANEL CELINE (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHANEL
Middle Name:CELINE
Last Name:DE FREITAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S MICHIGAN AVE STE 1433
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-6169
Mailing Address - Country:US
Mailing Address - Phone:847-529-8300
Mailing Address - Fax:
Practice Address - Street 1:122 S MICHIGAN AVE STE 1433
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6169
Practice Address - Country:US
Practice Address - Phone:847-529-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL170.014210101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional