Healthcare Provider Details

I. General information

NPI: 1265190854
Provider Name (Legal Business Name): YU-CHIH WANG MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTY WANG MA, LCPC

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S MICHIGAN AVE STE 309
CHICAGO IL
60616-0049
US

IV. Provider business mailing address

2600 S MICHIGAN AVE STE 309
CHICAGO IL
60616-0049
US

V. Phone/Fax

Practice location:
  • Phone: 798-898-7550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178011192
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180014870
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: