Healthcare Provider Details

I. General information

NPI: 1053679761
Provider Name (Legal Business Name): CHERYL LYNN PUGH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 W WASHINGTON BLVD FL 2
CHICAGO IL
60644-3496
US

IV. Provider business mailing address

5301 W WASHINGTON BLVD FL 2
CHICAGO IL
60644-3496
US

V. Phone/Fax

Practice location:
  • Phone: 312-316-7223
  • Fax:
Mailing address:
  • Phone: 312-316-7223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number26802
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180008113
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: