Provider Demographics
NPI:1801004296
Name:MILLER-RAZIK, MARY JO (MA, LCPC)
Entity type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:MILLER-RAZIK
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 E WOODFIELD RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4717
Mailing Address - Country:US
Mailing Address - Phone:847-240-5080
Mailing Address - Fax:847-240-1977
Practice Address - Street 1:800 E WOODFIELD RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4717
Practice Address - Country:US
Practice Address - Phone:847-240-5080
Practice Address - Fax:847-240-1977
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007212101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional