Provider Demographics
NPI:1700531787
Name:STRIPLING, THEODORE EDWARD (LCPC)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:EDWARD
Last Name:STRIPLING
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 1:1152 N KEDZIE AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-4182
Mailing Address - Country:US
Mailing Address - Phone:312-852-2111
Mailing Address - Fax:
Practice Address - Street 1:1152 N KEDZIE AVE APT 302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-4182
Practice Address - Country:US
Practice Address - Phone:312-852-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health