Active NPI
Martie Ryan Lukanich, PSY.D.,LCPC
- Professional Counselor
- Orland Park, IL
National Provider Identifier
1497886196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Practice address
- 9601 165TH St
Suite 6
Orland Park, IL 60467-5660 - Phone
- (708) 829-8277
- Fax
- (708) 352-2305
- NPI assigned
- Mar 7, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | IL | Primary |
Addresses
Primary practice location
9601 165TH St
Suite 6
Orland Park, IL 60467-5660
Mailing address
521 Bell Ave
La Grange, IL 60525-5903
Phone (708) 829-8277
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180003610 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497886196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "521 BELL AVE",
"city": "LA GRANGE",
"state": "IL",
"postal_code": "605255903",
"telephone_number": "708-829-8277",
"fax_number": "708-352-2305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9601 165TH ST",
"address_2": "SUITE 6",
"city": "ORLAND PARK",
"state": "IL",
"postal_code": "604675660",
"telephone_number": "708-829-8277",
"fax_number": "708-352-2305"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUKANICH",
"first_name": "MARTIE",
"middle_name": "RYAN",
"credential": "PSY.D.,LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orland Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.