Provider Demographics
NPI:1871285700
Name:TERI CICUREL, LCPC, PLLC
Entity type:Organization
Organization Name:TERI CICUREL, LCPC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:CICUREL
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-230-2025
Mailing Address - Street 1:9 W WALTON ST APT 1703
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7331
Mailing Address - Country:US
Mailing Address - Phone:773-230-2025
Mailing Address - Fax:
Practice Address - Street 1:9 W WALTON ST APT 1703
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-7331
Practice Address - Country:US
Practice Address - Phone:773-230-2025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health