Provider Demographics
NPI:1336359165
Name:HERBST, JOSEPH (LCPC, CADC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:HERBST
Suffix:
Gender:M
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 E LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-2980
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 W ROOSEVELT RD
Practice Address - Street 2:SUITE B5-204
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5260
Practice Address - Country:US
Practice Address - Phone:630-988-9751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL22197101YA0400X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635573OtherBLUE CROSS-BLUE SHIELD ID