Provider Demographics
NPI:1235488776
Name:OYARBIDE-SANCHEZ, MAYA (MA, LCPC)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:OYARBIDE-SANCHEZ
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 S. DAMEN AVE.
Mailing Address - Street 2:MEZZANINE SUITE C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608
Mailing Address - Country:US
Mailing Address - Phone:312-762-2745
Mailing Address - Fax:
Practice Address - Street 1:1340 S DAMEN AVE
Practice Address - Street 2:MEZZANINE SUITE C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608
Practice Address - Country:US
Practice Address - Phone:312-762-2745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6425-125101YP2500X
CO12750101YP2500X
IL180.011705101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional