Healthcare Provider Details

I. General information

NPI: 1013505965
Provider Name (Legal Business Name): TAYLOR EILEEN YRIGOYEN LCPC, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAYLOR EILEEN SALATA LPC, CADC

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 SKOKIE BLVD STE 103
NORTHBROOK IL
60062-4032
US

IV. Provider business mailing address

835 GARFIELD AVE
LIBERTYVILLE IL
60048-3164
US

V. Phone/Fax

Practice location:
  • Phone: 847-480-0300
  • Fax: 847-291-0576
Mailing address:
  • Phone: 847-980-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180013359
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: