Individual
JACK SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.C.P.C.
Contact information
Practice address
15040 S RAVINIA AVE STE 44, ORLAND PARK, IL 60462-3173
(708) 226-1280
(708) 226-5810
Mailing address
15040 S RAVINIA AVE STE 44, ORLAND PARK, IL 60462-3173
(708) 226-1280
(708) 226-5810
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
IL
Other
Enumeration date
05/10/2007
Last updated
07/08/2007
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