Provider Demographics
NPI:1346079498
Name:MARTINEZ UTRERA, TERESA CITLALI (MA, LPC)
Entity type:Individual
Prefix:
First Name:TERESA CITLALI
Middle Name:
Last Name:MARTINEZ UTRERA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 W HURON ST APT 909
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5338
Mailing Address - Country:US
Mailing Address - Phone:872-218-1933
Mailing Address - Fax:
Practice Address - Street 1:2259 S DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4232
Practice Address - Country:US
Practice Address - Phone:872-281-7575
Practice Address - Fax:773-801-0084
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.020259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health