Provider Demographics
NPI:1861836405
Name:RIETVELD, ADAM JOSEPH (MA, LCPC)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:JOSEPH
Last Name:RIETVELD
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N VIRGINIA ST STE 110
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3454
Mailing Address - Country:US
Mailing Address - Phone:630-267-9144
Mailing Address - Fax:
Practice Address - Street 1:101 N VIRGINIA ST STE 110
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3454
Practice Address - Country:US
Practice Address - Phone:815-265-6561
Practice Address - Fax:224-330-1928
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009477101YM0800X
IL178.008280101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health