Provider Demographics
NPI:1184289365
Name:HERBERT, ALLISON HALL (MA, LCP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:HALL
Last Name:HERBERT
Suffix:
Gender:F
Credentials:MA, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N GREEN ST UNIT 211
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2338
Mailing Address - Country:US
Mailing Address - Phone:281-799-7944
Mailing Address - Fax:
Practice Address - Street 1:120 N GREEN ST UNIT 211
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2338
Practice Address - Country:US
Practice Address - Phone:281-799-7944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.013915101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor