Provider Demographics
NPI:1982356887
Name:SANTIAGO, ALEXIS E (LPC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:E
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S MICHIGAN AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-0049
Mailing Address - Country:US
Mailing Address - Phone:773-234-8779
Mailing Address - Fax:773-496-0494
Practice Address - Street 1:2600 S MICHIGAN AVE STE 309
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-0049
Practice Address - Country:US
Practice Address - Phone:773-234-8779
Practice Address - Fax:773-496-0494
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017737101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional