Healthcare Provider Details

I. General information

NPI: 1265365274
Provider Name (Legal Business Name): THOMAS E AGAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 RAVINE WAY STE 200
GLENVIEW IL
60025-7649
US

IV. Provider business mailing address

2440 RAVINE WAY STE 200
GLENVIEW IL
60025-7649
US

V. Phone/Fax

Practice location:
  • Phone: 847-730-3042
  • Fax:
Mailing address:
  • Phone: 847-730-3042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.022739
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: