Provider Demographics
NPI:1194148056
Name:BARCZAK, HOLLY ANN (LCPC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:BARCZAK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:VANDEWALK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:225 WEST WASHINGTON
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606
Mailing Address - Country:US
Mailing Address - Phone:630-586-0900
Mailing Address - Fax:630-586-9990
Practice Address - Street 1:225 WEST WASHINGTON
Practice Address - Street 2:SUITE 2200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606
Practice Address - Country:US
Practice Address - Phone:312-380-1203
Practice Address - Fax:630-586-9990
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006398101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health