Provider Demographics
NPI:1659383826
Name:JANA, EDWARD CHARLES (LCPC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:CHARLES
Last Name:JANA
Suffix:
Gender:
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 LONGCOMMON RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1706
Mailing Address - Country:US
Mailing Address - Phone:708-447-1965
Mailing Address - Fax:
Practice Address - Street 1:20 N CLARK ST STE 2750
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-5103
Practice Address - Country:US
Practice Address - Phone:866-296-5262
Practice Address - Fax:877-991-8819
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-000658101YP2500X
IL180000658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional