Provider Demographics
NPI:1043720188
Name:KONOPA, AMBER (LCPC, CADC, CTRS)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:KONOPA
Suffix:
Gender:F
Credentials:LCPC, CADC, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9S060 LAKE DR APT 106
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2534
Mailing Address - Country:US
Mailing Address - Phone:815-355-1218
Mailing Address - Fax:
Practice Address - Street 1:600 S WASHINGTON ST STE 105
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6665
Practice Address - Country:US
Practice Address - Phone:630-206-4060
Practice Address - Fax:855-871-8351
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL25619101YA0400X
IL178.011041101YM0800X, 101YP2500X
IL180013893101YP2500X
IL49087225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist