Healthcare Provider Details

I. General information

NPI: 1700934213
Provider Name (Legal Business Name): CYNTHIA YOUNG PETERS M.S., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NORTH SHORE DR SUITE 106
LAKE BLUFF IL
60044-2243
US

IV. Provider business mailing address

900 NORTH SHORE DR SUITE 106
LAKE BLUFF IL
60044-2243
US

V. Phone/Fax

Practice location:
  • Phone: 224-365-4067
  • Fax: 866-861-2168
Mailing address:
  • Phone: 224-365-4067
  • Fax: 866-861-2168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number62355
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166.000805
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number201094
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: