Provider Demographics
NPI:1154884013
Name:ARREOLA, MARISOL GUADALUPE
Entity type:Individual
Prefix:MRS
First Name:MARISOL
Middle Name:GUADALUPE
Last Name:ARREOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARISOL
Other - Middle Name:GUADALUPE
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1536 S 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-1663
Mailing Address - Country:US
Mailing Address - Phone:773-419-6274
Mailing Address - Fax:
Practice Address - Street 1:5341 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2817
Practice Address - Country:US
Practice Address - Phone:708-656-6430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC12054790799OtherDL