Provider Demographics
NPI:1235965088
Name:MCCORMICK, REESE STELLA (LSW)
Entity type:Individual
Prefix:MS
First Name:REESE
Middle Name:STELLA
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S STATE ST APT 600
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3178
Mailing Address - Country:US
Mailing Address - Phone:312-320-6663
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE
Practice Address - Street 2:SUITE 508
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7708
Practice Address - Country:US
Practice Address - Phone:475-273-8697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.113581101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health