Provider Demographics
NPI:1881444685
Name:CLINES, MAGGIE CLINES (MED, LPC)
Entity type:Individual
Prefix:
First Name:MAGGIE CLINES
Middle Name:
Last Name:CLINES
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3507
Mailing Address - Country:US
Mailing Address - Phone:773-988-0194
Mailing Address - Fax:
Practice Address - Street 1:32 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4060
Practice Address - Country:US
Practice Address - Phone:847-823-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019484101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional