Provider Demographics
NPI:1467832188
Name:CLOSE, SUSAN (LCPC, LMHC, NCC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:CLOSE
Suffix:
Gender:F
Credentials:LCPC, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E EVERGREEN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3240
Mailing Address - Country:US
Mailing Address - Phone:847-544-0135
Mailing Address - Fax:
Practice Address - Street 1:200 E EVERGREEN AVE STE 103
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3240
Practice Address - Country:US
Practice Address - Phone:847-544-0135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178005108101YP2500X
IL180013294101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN39004631AOtherINDIANA PROFESSIONAL LICENSING AGENCY, BEHAVIORAL HEALTH & HUMAN SERVICES BOARD