Provider Demographics
NPI:1841859394
Name:BURNETT, TICHINA MONIQUE (LCPC)
Entity type:Individual
Prefix:
First Name:TICHINA
Middle Name:MONIQUE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:TICHINA
Other - Middle Name:MONIQUE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8448 S BURLEY AVE # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2615
Mailing Address - Country:US
Mailing Address - Phone:708-691-2889
Mailing Address - Fax:
Practice Address - Street 1:1 WESTBROOK CORPORATE CTR STE 300
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5709
Practice Address - Country:US
Practice Address - Phone:312-550-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-09
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178011843101YM0800X
IL180014204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty