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General NPI Number Information
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NPI Number | 1245129170
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Entity Type | Organization
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Legal Business Name | MYCELIUM MENTAL HEALTH PLLC
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 1590 S MILWAUKEE AVE STE 210
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-3785
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Country | US
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Telephone | 847-637-7516
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5970
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City | VERNON HILLS
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State | IL
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Zip | 60061-5970
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | WENDY YOU
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Credential | MD
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Telephone | 847-637-7516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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