Provider Demographics
NPI:1336554179
Name:BARNUM, ALISHA RYBICKI (MA, LCPC)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:RYBICKI
Last Name:BARNUM
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N 2ND ST STE 201D
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1852
Mailing Address - Country:US
Mailing Address - Phone:630-797-9192
Mailing Address - Fax:
Practice Address - Street 1:1202 KING JAMES AVE
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-7817
Practice Address - Country:US
Practice Address - Phone:815-494-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL178.010022101YP2500X
IL180010472101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health