Healthcare Provider Details

I. General information

NPI: 1730447657
Provider Name (Legal Business Name): ANTHONY SCOTT DILLON M.A., LCPC, CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2012
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 KENSINGTON RD UNIT 4531
OAK BROOK IL
60522-7136
US

IV. Provider business mailing address

7956 BIRCH DR
HAMMOND IN
46324-3329
US

V. Phone/Fax

Practice location:
  • Phone: 630-324-4996
  • Fax: 219-844-0195
Mailing address:
  • Phone: 219-781-1113
  • Fax: 219-844-0195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180008405
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: