Healthcare Provider Details

I. General information

NPI: 1265235196
Provider Name (Legal Business Name): SAMANTHA VERONICA NGUYEN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W IRVING PARK RD APT 4304
CHICAGO IL
60613-6300
US

IV. Provider business mailing address

2743 N AVERS AVE
CHICAGO IL
60647-1017
US

V. Phone/Fax

Practice location:
  • Phone: 773-304-8723
  • Fax:
Mailing address:
  • Phone: 773-245-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.017704
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: