Provider Demographics
NPI:1295278760
Name:MCCHESNEY, MARY RYAN (LCPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:RYAN
Last Name:MCCHESNEY
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 1:1800 W ROSCOE ST
Mailing Address - Street 2:534
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1049
Mailing Address - Country:US
Mailing Address - Phone:404-625-6222
Mailing Address - Fax:
Practice Address - Street 1:1440 N KINGSBURY ST STE 219
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2690
Practice Address - Country:US
Practice Address - Phone:404-625-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012467101Y00000X
IL180012233101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor