Individual
CHARLES MICHAEL IDERAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.MIN., LCPC
Contact information
Practice address
6006 W. 159TH ST, BLDG. C, OAK FOREST, IL 60452
(708) 535-7320
Mailing address
1404 BRASSIE AVE, FLOSSMOOR, IL 60422-1814
(708) 922-1194
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC 180-001087
IL
101YP2500X
Professional Counselor
180001087
IL
Other
Enumeration date
07/28/2006
Last updated
12/04/2024
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