Provider Demographics
NPI:1437474681
Name:WOLFE, MIRIAM (MA, LCPC)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 512
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7511
Mailing Address - Country:US
Mailing Address - Phone:312-729-5258
Mailing Address - Fax:312-729-5259
Practice Address - Street 1:155 N. MICHIGAN AVE
Practice Address - Street 2:SUITE 512
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7612
Practice Address - Country:US
Practice Address - Phone:312-729-5258
Practice Address - Fax:312-729-5259
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007476101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional