Provider Demographics
NPI:1205269057
Name:MUCKIAN, JOHN PETER JR (LPC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PETER
Last Name:MUCKIAN
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13136 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2423
Mailing Address - Country:US
Mailing Address - Phone:708-974-5800
Mailing Address - Fax:708-371-0466
Practice Address - Street 1:13136 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2423
Practice Address - Country:US
Practice Address - Phone:708-974-5800
Practice Address - Fax:708-371-0466
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.002469101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional