Healthcare Provider Details

I. General information

NPI: 1821320987
Provider Name (Legal Business Name): SCOTT M. CYPHERS LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2010
Last Update Date: 01/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E DIEHL RD STE 121
NAPERVILLE IL
60563-4812
US

IV. Provider business mailing address

11611 RONALD ST
HUNTLEY IL
60142-7107
US

V. Phone/Fax

Practice location:
  • Phone: 630-983-0600
  • Fax:
Mailing address:
  • Phone: 847-961-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.004716
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: