Provider Demographics
NPI:1912038910
Name:WUNDERLICH, RAYMOND C JR (LCPC)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:C
Last Name:WUNDERLICH
Suffix:JR
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 W HALF DAY RD
Mailing Address - Street 2:PMB 284
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6547
Mailing Address - Country:US
Mailing Address - Phone:847-380-4806
Mailing Address - Fax:
Practice Address - Street 1:4160 IL ROUTE 83 STE 204
Practice Address - Street 2:
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-8034
Practice Address - Country:US
Practice Address - Phone:847-380-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-002811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional