Basic Information
| Provider Information | |||||||||
| NPI: | 1669503439 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PORIS | ||||||||
| FirstName: | PAGE | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 745 S 8TH ST | ||||||||
| Address2: | |||||||||
| City: | WEST DUNDEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601182108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004287260 | ||||||||
| FaxNumber: | 8474287269 | ||||||||
| Practice Location | |||||||||
| Address1: | 745 S 8TH ST | ||||||||
| Address2: | |||||||||
| City: | WEST DUNDEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601182108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004287260 | ||||||||
| FaxNumber: | 8474287269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 08/07/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 180003462 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.