Provider Demographics
NPI:1356884134
Name:ZAVAKOS, CLINT (MA LCPC)
Entity type:Individual
Prefix:MR
First Name:CLINT
Middle Name:
Last Name:ZAVAKOS
Suffix:
Gender:M
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N MICHIGAN AVE STE 1008
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5310
Mailing Address - Country:US
Mailing Address - Phone:773-234-3121
Mailing Address - Fax:
Practice Address - Street 1:307 N MICHIGAN AVE STE 1008
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5310
Practice Address - Country:US
Practice Address - Phone:773-234-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010641101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180010641OtherLCPC LICENSE