Provider Demographics
NPI:1174289227
Name:DEVRIES, MEREDITH GRACE (LPC)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:GRACE
Last Name:DEVRIES
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 1:1457 N HALSTED ST UNIT B303
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2677
Mailing Address - Country:US
Mailing Address - Phone:269-903-5896
Mailing Address - Fax:
Practice Address - Street 1:1457 N HALSTED ST UNIT B303
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2677
Practice Address - Country:US
Practice Address - Phone:312-243-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017460101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional