| Doctor Name: | MR. JOHN PETER MUCKIAN |
| NPI Number: | 1205269057 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | 178.002469 |
| Business Practice Address: | 13136 Western Ave Blue Island, IL - 604062423 |
| Business Phone Number: | 7089745800 |
| Business Fax Number: | 7083710466 |
| Mailing Address: | 13136 Western Ave, BLUE ISLAND |
| State: | IL |
| Postal Code: | 604062423 |
| Phone Number: | 7089745800 |
| Fax Number: | 7083710466 |
| NPI Enumeration Date: | 08/15/2013 |
| NPI Last Update Date: | 08/15/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 178.002469 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |