Provider Demographics
NPI:1780742783
Name:IBARRA, DOROTHY R (LCPC)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:R
Last Name:IBARRA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16012 S HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-2301
Mailing Address - Country:US
Mailing Address - Phone:815-439-9625
Mailing Address - Fax:
Practice Address - Street 1:120 E OGDEN AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3542
Practice Address - Country:US
Practice Address - Phone:630-325-5300
Practice Address - Fax:630-325-5309
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional