Provider Demographics
NPI:1831101203
Name:RICE, BRIAN IMAS (MS ED, LCPC, CADC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:IMAS
Last Name:RICE
Suffix:
Gender:M
Credentials:MS ED, LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-2502
Mailing Address - Country:US
Mailing Address - Phone:630-334-0249
Mailing Address - Fax:630-270-2071
Practice Address - Street 1:819 OAK AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-3115
Practice Address - Country:US
Practice Address - Phone:630-334-0249
Practice Address - Fax:630-270-2071
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003422101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional