Provider Demographics
NPI:1063229417
Name:FAKHOURI, MARIA (PSYD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:FAKHOURI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 N STATE ST APT 2911
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-7237
Mailing Address - Country:US
Mailing Address - Phone:312-636-7486
Mailing Address - Fax:
Practice Address - Street 1:333 N MICHIGAN AVE STE 2400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-4040
Practice Address - Country:US
Practice Address - Phone:773-609-0361
Practice Address - Fax:312-896-5595
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071011351103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical