Provider Demographics
NPI:1891266391
Name:INIGUEZ, JOSE DE JESUS (PHD, LCPC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:DE JESUS
Last Name:INIGUEZ
Suffix:
Gender:M
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4043 S RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-1831
Mailing Address - Country:US
Mailing Address - Phone:773-491-9815
Mailing Address - Fax:
Practice Address - Street 1:2755 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4244
Practice Address - Country:US
Practice Address - Phone:773-252-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-09
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011950101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional