Provider Demographics
NPI:1376898312
Name:SANCHEZ, MYRIAM LECLERC (MA, LCPC)
Entity type:Individual
Prefix:MRS
First Name:MYRIAM
Middle Name:LECLERC
Last Name:SANCHEZ
Suffix:
Gender:F
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 1:800 ROOSEVELT RD STE E220
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5868
Mailing Address - Country:US
Mailing Address - Phone:630-478-0707
Mailing Address - Fax:630-381-0905
Practice Address - Street 1:800 ROOSEVELT RD STE E220
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5868
Practice Address - Country:US
Practice Address - Phone:630-478-0707
Practice Address - Fax:630-381-0905
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010230101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional