Provider Demographics
NPI:1730959743
Name:ABRAHAM, MICHELLE LYNN (LPC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1353
Mailing Address - Country:US
Mailing Address - Phone:773-203-2158
Mailing Address - Fax:
Practice Address - Street 1:3633 W LAKE AVE STE 308
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5803
Practice Address - Country:US
Practice Address - Phone:847-901-3323
Practice Address - Fax:847-904-0903
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019525101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional