Provider Demographics
NPI:1366260556
Name:VONGLUEKIAT, ANITA (LPC)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:VONGLUEKIAT
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 1:7116 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-5933
Mailing Address - Country:US
Mailing Address - Phone:312-433-9815
Mailing Address - Fax:
Practice Address - Street 1:9730 S WESTERN AVE STE 418
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2777
Practice Address - Country:US
Practice Address - Phone:630-664-3658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178020554101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health