Healthcare Provider Details

I. General information

NPI: 1023148103
Provider Name (Legal Business Name): STEVE J. PLOUM M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10540 S WESTERN AVE SUITE 506
CHICAGO IL
60643-2536
US

IV. Provider business mailing address

1418 WILLOW RD
HOMEWOOD IL
60430-3437
US

V. Phone/Fax

Practice location:
  • Phone: 708-297-0102
  • Fax: 773-614-8078
Mailing address:
  • Phone: 708-297-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180 002268
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: