Provider Demographics
NPI:1740256874
Name:NOVAK, CHRISTINE M (LCPC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:NOVAK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-0364
Mailing Address - Country:US
Mailing Address - Phone:815-501-2088
Mailing Address - Fax:815-220-0843
Practice Address - Street 1:1315 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:IL
Practice Address - Zip Code:61342-1447
Practice Address - Country:US
Practice Address - Phone:815-501-2088
Practice Address - Fax:815-220-0843
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
245739OtherCOMPSYCH
623783OtherBCBS IL