Individual
DAVID DE LA FUENTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
474 SUMMIT ST, ELGIN, IL 60120-3829
(847) 608-2682
Mailing address
1600 MARTHA DR, ELGIN, IL 60123-5924
(847) 931-4408
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/08/2012
Last updated
02/08/2012
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