Provider Demographics
NPI:1861044729
Name:TOME, ITXASNE (LCPC)
Entity Type:Individual
Prefix:
First Name:ITXASNE
Middle Name:
Last Name:TOME
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 1:3020 N SHEFFIELD AVE APT 1N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-8466
Mailing Address - Country:US
Mailing Address - Phone:773-397-6693
Mailing Address - Fax:
Practice Address - Street 1:2801 N SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5003
Practice Address - Country:US
Practice Address - Phone:773-281-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health