Provider Demographics
NPI:1467253120
Name:CLUCAS, THERESE
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:CLUCAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 W MEDILL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-0538
Mailing Address - Country:US
Mailing Address - Phone:630-804-9450
Mailing Address - Fax:
Practice Address - Street 1:33 W HIGGINS RD
Practice Address - Street 2:
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9115
Practice Address - Country:US
Practice Address - Phone:773-280-7405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health