Samantha Maciaga
Individual provider Active NPI Professional Counselor · Tinley Park, IL
NPI 1972162808 · NPPES record last updated Jun 13, 2019
Key facts
- NPI
- 1972162808
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 178.012902 (IL)
- Practice address
- 6819 167TH St
Tinley Park, IL 60477-2501 - Phone
- (708) 633-8000
- NPI assigned
- Jun 13, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.012902 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Olive Branch Counseling Associates, Inc. | Past |
Accepting new patients | |
| Olive Branch Counseling Associates, Inc. | Professional | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178.012902 | IL | Yes |
Addresses
Primary practice location
6819 167TH St
Tinley Park, IL 60477-2501
Mailing address
6819 167TH St
Tinley Park, IL 60477-2501
Phone (630) 296-7665
Other providers in Tinley Park, IL
- Mary Elizabeth Lunter
- Luxottica of America Inc
- Luxottica of America Inc
- Jennifer Maureen Lydon
- Danielle Lyon
- Mary Beth Madden Damm
- Isabella Magana
- Krystal Maiden
- Dharvin Maisuria
- Malhotra LLC
All providers in Tinley Park, IL · Professional Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.