Healthcare Provider Details

I. General information

NPI: 1518730464
Provider Name (Legal Business Name): AUDREY MAST LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SALT CREEK LN STE 202
HINSDALE IL
60521-2903
US

IV. Provider business mailing address

923 OHIO CT
CAROL STREAM IL
60188-1351
US

V. Phone/Fax

Practice location:
  • Phone: 847-432-5464
  • Fax:
Mailing address:
  • Phone: 630-525-0474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.018181
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: