Provider Demographics
NPI:1871200311
Name:HUSEJNOVIC, MEDINA (LPC)
Entity type:Individual
Prefix:
First Name:MEDINA
Middle Name:
Last Name:HUSEJNOVIC
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 W GOLF RD APT 4I
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-5738
Mailing Address - Country:US
Mailing Address - Phone:847-913-3769
Mailing Address - Fax:
Practice Address - Street 1:3375 N ARLINGTON HEIGHTS RD STE J
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7701
Practice Address - Country:US
Practice Address - Phone:847-242-1599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.018069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional