Provider Demographics
NPI:1285800318
Name:DENNIS, THOMAS JOHN (LCPC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:DENNIS
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 1:1 CAYUGA TRL
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:IL
Mailing Address - Zip Code:61036-9430
Mailing Address - Country:US
Mailing Address - Phone:773-454-9176
Mailing Address - Fax:
Practice Address - Street 1:800 SPRING ST STE 101
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036-2003
Practice Address - Country:US
Practice Address - Phone:773-454-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.006879OtherCLINICAL PROFESSIONAL COUNSELOR