Healthcare Provider Details

I. General information

NPI: 1902448194
Provider Name (Legal Business Name): NATALIE JEUNG MA, LCPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 UNIVERSITY PL STE 330
EVANSTON IL
60201-3156
US

IV. Provider business mailing address

5225 OLD ORCHARD RD STE 37
SKOKIE IL
60077-1027
US

V. Phone/Fax

Practice location:
  • Phone: 847-529-8300
  • Fax:
Mailing address:
  • Phone: 847-529-8300
  • Fax: 847-529-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.015211
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.014641
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: