Provider Demographics
NPI:1770687030
Name:RAINE, JOHN MARTIN (LCPC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MARTIN
Last Name:RAINE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:MARTIN
Other - Last Name:RAINE-OKUBO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:2430 GREENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4870
Mailing Address - Country:US
Mailing Address - Phone:847-724-5233
Mailing Address - Fax:847-724-5260
Practice Address - Street 1:ADVOCATE HEALTH CENTER SPECIALTY 4
Practice Address - Street 2:2545 S. DR. M. L. KING DRIVE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616
Practice Address - Country:US
Practice Address - Phone:312-808-4589
Practice Address - Fax:312-842-7859
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001625669OtherBCBS PROVIDER NUMBER