Healthcare Provider Details

I. General information

NPI: 1306993522
Provider Name (Legal Business Name): DREW M MJOEN M.A., LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 S MILWAUKEE AVE STE 307
LIBERTYVILLE IL
60048-3773
US

IV. Provider business mailing address

1580 S MILWAUKEE AVE STE 307
LIBERTYVILLE IL
60048-3773
US

V. Phone/Fax

Practice location:
  • Phone: 847-557-0645
  • Fax: 847-557-9809
Mailing address:
  • Phone: 847-557-0645
  • Fax: 847-557-9809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: