Provider Demographics
NPI:1023169695
Name:LICHT, JAN CATHY (MA, LCPC, CADC)
Entity type:Individual
Prefix:MRS
First Name:JAN
Middle Name:CATHY
Last Name:LICHT
Suffix:
Gender:F
Credentials:MA, LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 PORTAGE ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-6013
Mailing Address - Country:US
Mailing Address - Phone:630-661-5936
Mailing Address - Fax:
Practice Address - Street 1:29W522 BATAVIA RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-2007
Practice Address - Country:US
Practice Address - Phone:630-661-5936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional