Provider Demographics
NPI:1225761182
Name:BAZAN, MARY FRANCE (LCPC)
Entity type:Individual
Prefix:
First Name:MARY FRANCE
Middle Name:
Last Name:BAZAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 W 55TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3565
Mailing Address - Country:US
Mailing Address - Phone:708-688-9171
Mailing Address - Fax:
Practice Address - Street 1:475 W 55TH ST STE 108
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-3565
Practice Address - Country:US
Practice Address - Phone:708-688-9171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180014515101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional