Provider Demographics
NPI:1245459106
Name:JAVIER-ETAPA, ANA LILIA (LCPC)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:LILIA
Last Name:JAVIER-ETAPA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9519 S TRUMBULL AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-3058
Mailing Address - Country:US
Mailing Address - Phone:708-200-1306
Mailing Address - Fax:
Practice Address - Street 1:10540 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2536
Practice Address - Country:US
Practice Address - Phone:708-200-1306
Practice Address - Fax:708-634-2814
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007559101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202591OtherMEDICARE
IL1617631OtherBLUE CROSS BLUE SHIELD