Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003065236 |
---|---|
Provider Name | Crystal Lynn Novak |
First Address | Elk Grove Village, IL 60007-3217 |
Second Address | Elk Grove Village, IL 60007-3217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2008 |
Last Update Date | 11/09/2008 |