Provider Demographics
NPI:1750525119
Name:MIROBALLI, LINDSAY (MA, LPC)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:MIROBALLI
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15601 CICERO AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-3636
Mailing Address - Country:US
Mailing Address - Phone:708-687-3479
Mailing Address - Fax:708-687-3480
Practice Address - Street 1:15601 CICERO AVE STE 103
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-3636
Practice Address - Country:US
Practice Address - Phone:708-687-3479
Practice Address - Fax:708-687-3480
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.005640101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional