Provider Demographics
NPI:1780963462
Name:TERRY LEE D'AMICO & ASSOCIATES IN COUNSELING, LLC
Entity type:Organization
Organization Name:TERRY LEE D'AMICO & ASSOCIATES IN COUNSELING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:708-301-6311
Mailing Address - Street 1:15750 S BELL RD
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8412
Mailing Address - Country:US
Mailing Address - Phone:708-301-6311
Mailing Address - Fax:408-228-0891
Practice Address - Street 1:15750 S BELL RD
Practice Address - Street 2:SUITE 2E
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8412
Practice Address - Country:US
Practice Address - Phone:708-301-6311
Practice Address - Fax:408-228-0891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005604251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health