Provider Demographics
NPI:1518330232
Name:ANSARI, MOLLY (LCPC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:ANSARI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:DUTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:854 SEMINARY CIR
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6158
Mailing Address - Country:US
Mailing Address - Phone:920-698-1886
Mailing Address - Fax:
Practice Address - Street 1:29W170 BUTTERFIELD RD STE 103
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-2807
Practice Address - Country:US
Practice Address - Phone:331-465-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL1800009952101YP2500X
IL180.009952101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health