Provider Demographics
NPI:1528420213
Name:BRASSEA, GEORGE III (LCPC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:BRASSEA
Suffix:III
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 1:210 N ARQUILLA DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-1702
Mailing Address - Country:US
Mailing Address - Phone:708-769-5015
Mailing Address - Fax:
Practice Address - Street 1:222 VOLLMER RD STE AA
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1886
Practice Address - Country:US
Practice Address - Phone:708-248-7039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011327101YP2500X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional