Provider Demographics
NPI:1164948329
Name:DE WET, PHILIPPUS BERNARDUS (LCPC)
Entity type:Individual
Prefix:MR
First Name:PHILIPPUS
Middle Name:BERNARDUS
Last Name:DE WET
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 N LAKE SHORE DR APT 34B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4844
Mailing Address - Country:US
Mailing Address - Phone:773-308-4164
Mailing Address - Fax:
Practice Address - Street 1:1731 N MARCEY ST STE 510
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7955
Practice Address - Country:US
Practice Address - Phone:312-618-4867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-19
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180013050101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional