Provider Demographics
NPI:1295070209
Name:GOLDMAN, MICHAEL B (LPC CRADC CEAP PCGC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:B
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:LPC CRADC CEAP PCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MULBERRY CT
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3348
Mailing Address - Country:US
Mailing Address - Phone:847-832-9500
Mailing Address - Fax:847-832-9530
Practice Address - Street 1:22 MULBERRY CT
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3348
Practice Address - Country:US
Practice Address - Phone:847-832-9500
Practice Address - Fax:847-832-9530
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-02
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.004029101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor