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General NPI Number Information
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NPI Number | 1740163401
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Entity Type | Individual
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Provider Name | YAO GAUTIER AMEGAN MA, LPC
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Gender | Male
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Dates
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Enumeration Date | 07/30/2025
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 53 W JACKSON BLVD STE 1615
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City | CHICAGO
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State | IL
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Zip | 60604-3722
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Country | US
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Telephone | 773-234-6581
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Fax |
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Provider Business Mailing Address
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Address Line | 10479 DEARLOVE RD APT 2A
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City | GLENVIEW
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State | IL
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Zip | 60025-3516
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Country | US
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Telephone | 360-508-4035
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178.021890
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License Number State | IL
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