Provider Demographics
NPI:1104253319
Name:OSTERLOO, DANIEL (LCPC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:OSTERLOO
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 1:3526 N CALIFORNIA AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-1164
Mailing Address - Country:US
Mailing Address - Phone:181-540-8052
Mailing Address - Fax:
Practice Address - Street 1:3526 N CALIFORNIA AVE STE 204
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-1164
Practice Address - Country:US
Practice Address - Phone:181-540-8052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010635101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health