Healthcare Provider Details

I. General information

NPI: 1609672500
Provider Name (Legal Business Name): MYCAH JANELLE HOAGLIN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938 N CALIFORNIA AVE
CHICAGO IL
60622-4462
US

IV. Provider business mailing address

1832 S RACINE AVE APT 2F
CHICAGO IL
60608-3214
US

V. Phone/Fax

Practice location:
  • Phone: 312-620-0408
  • Fax: 312-248-2595
Mailing address:
  • Phone: 314-285-7487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.01683
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: