Healthcare Provider Details

I. General information

NPI: 1649574484
Provider Name (Legal Business Name): JESSICA YOUNG LCPC, BC-DMT, GLCMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W BUTTERFIELD RD STE 245
ELMHURST IL
60126-5097
US

IV. Provider business mailing address

5316 N OKETO AVE
CHICAGO IL
60656-1761
US

V. Phone/Fax

Practice location:
  • Phone: 630-478-0488
  • Fax:
Mailing address:
  • Phone: 773-706-4302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180004954
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: