Provider Demographics
NPI:1528784543
Name:EGAN, MAIRA ANNE (LPC, ATR-P)
Entity type:Individual
Prefix:
First Name:MAIRA
Middle Name:ANNE
Last Name:EGAN
Suffix:
Gender:F
Credentials:LPC, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 N ALBANY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1667
Mailing Address - Country:US
Mailing Address - Phone:773-865-4193
Mailing Address - Fax:
Practice Address - Street 1:1811 W NORTH AVE STE 402
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-0204
Practice Address - Country:US
Practice Address - Phone:312-819-7381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
221700000X
IL178.021294101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist