Healthcare Provider Details

I. General information

NPI: 1255202776
Provider Name (Legal Business Name): CHURAN WU LPC, NCC, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 N LAKEWOOD AVE
CHICAGO IL
60657-3215
US

IV. Provider business mailing address

1720 OAK AVE UNIT 511
EVANSTON IL
60201-5983
US

V. Phone/Fax

Practice location:
  • Phone: 872-278-3286
  • Fax:
Mailing address:
  • Phone: 872-274-4344
  • Fax: 866-671-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.022059
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: