Provider Demographics
NPI:1174113617
Name:DEULIN-BRTICEVICH, PAGE (LPC)
Entity type:Individual
Prefix:
First Name:PAGE
Middle Name:
Last Name:DEULIN-BRTICEVICH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6524 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1504
Mailing Address - Country:US
Mailing Address - Phone:773-704-9811
Mailing Address - Fax:
Practice Address - Street 1:18328 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-3403
Practice Address - Country:US
Practice Address - Phone:708-505-2143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.008639101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health