Healthcare Provider Details

I. General information

NPI: 1316324312
Provider Name (Legal Business Name): MICHAEL HENDON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

588 LINCOLN AVE STE 200
WINNETKA IL
60093-2308
US

IV. Provider business mailing address

588 LINCOLN AVE STE 200
WINNETKA IL
60093-2308
US

V. Phone/Fax

Practice location:
  • Phone: 773-681-9212
  • Fax:
Mailing address:
  • Phone: 773-681-9212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.009285
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.010385
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: