Provider Demographics
NPI:1992158638
Name:BURBACK, CHRISTINE M (LCPC NCC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:BURBACK
Suffix:
Gender:F
Credentials:LCPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 OLDE HALF DAY RD STE 100-6
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3008
Mailing Address - Country:US
Mailing Address - Phone:847-748-2558
Mailing Address - Fax:847-301-3633
Practice Address - Street 1:175 OLDE HALF DAY RD STE 100-6
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3008
Practice Address - Country:US
Practice Address - Phone:847-748-2558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012153101YM0800X, 101YP2500X
IL180.012914101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health