Healthcare Provider Details

I. General information

NPI: 1720844251
Provider Name (Legal Business Name): MARK LIVSHOTS LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NORTH SHORE DR STE 200
LAKE BLUFF IL
60044-2225
US

IV. Provider business mailing address

30 N MICHIGAN AVE STE 1126
CHICAGO IL
60602-3737
US

V. Phone/Fax

Practice location:
  • Phone: 847-238-2458
  • Fax:
Mailing address:
  • Phone: 312-481-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.017910
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: