Healthcare Provider Details

I. General information

NPI: 1205482379
Provider Name (Legal Business Name): MEGAN ESCUTIA LPC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 N SANGAMON ST STE 200
CHICAGO IL
60607-2201
US

IV. Provider business mailing address

3700 TENNYSON ST UNIT 12451
DENVER CO
80212-4418
US

V. Phone/Fax

Practice location:
  • Phone: 312-487-1179
  • Fax:
Mailing address:
  • Phone: 312-487-1179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.012600
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.012302
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: