Healthcare Provider Details

I. General information

NPI: 1700629334
Provider Name (Legal Business Name): EMERALD PATH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 DEAN ST STE 550
SAINT CHARLES IL
60175-4819
US

IV. Provider business mailing address

2325 DEAN ST STE 550
SAINT CHARLES IL
60175-4819
US

V. Phone/Fax

Practice location:
  • Phone: 630-345-6345
  • Fax: 630-389-4354
Mailing address:
  • Phone: 630-345-6345
  • Fax: 630-389-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. ANGIE MEI ZHIN YONG
Title or Position: OWNER & CEO
Credential: MA
Phone: 630-345-6345