Provider Demographics
NPI:1720105018
Name:BEUKEMA, GEORGE D (LCPC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:D
Last Name:BEUKEMA
Suffix:
Gender:M
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:P.O. BOX 577886
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-350-2953
Mailing Address - Fax:773-281-0478
Practice Address - Street 1:3257 N SHEFFIELD AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2270
Practice Address - Country:US
Practice Address - Phone:773-350-2953
Practice Address - Fax:773-281-0478
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007055101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor