Basic Information
| Provider Information | |||||||||
| NPI: | 1831434869 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARLEY | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15127 S 73RD AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604624398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085869303 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15127 S 73RD AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604624398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085869303 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2012 | ||||||||
| LastUpdateDate: | 12/03/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 180.008441 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.