Provider Demographics
NPI:1922425222
Name:RAGO, TINA MARIE (PSYD, LCPC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:RAGO
Suffix:
Gender:F
Credentials:PSYD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18700 WOLF RD STE 245
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8603
Mailing Address - Country:US
Mailing Address - Phone:708-692-8462
Mailing Address - Fax:
Practice Address - Street 1:18700 WOLF RD STE 245
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8603
Practice Address - Country:US
Practice Address - Phone:708-692-8462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008995101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional