MEDICARE: PEGGY HOUGH L.C.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor		IL

General Provider Information

NPI Number	:	1144493057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY HOUGH L.C.P.C.

Provider Business Mailing Address
First Line	:	2530 CRAWFORD AVE
Second Line	:	SUITE 114
City	:	EVANSTON
State	:	IL
Zip	:	60201-4954
Country	:	US
Telephone Number	:	847-425-1778
Fax Number	:	847-563-8162

Provider Business Practice Location Address
First Line	:	2530 CRAWFORD AVE
Second Line	:	SUITE 114
City	:	EVANSTON
State	:	IL
Zip	:	60201-4970
Country	:	US
Telephone Number	:	847-425-1778
Fax Number	:	847-563-8162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	04/11/2008

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