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General NPI Number Information
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NPI Number | 1801155080
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Entity Type | Organization
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Legal Business Name | BRYAN BUGAY, LCPC
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 550 W FRONTAGE RD SUITE 3515
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City | NORTHFIELD
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State | IL
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Zip | 60093-1202
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Country | US
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Telephone | 773-318-8959
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Fax |
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Provider Business Mailing Address
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Address Line | 550 W FRONTAGE RD SUITE 3515
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City | NORTHFIELD
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State | IL
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Zip | 60093-1202
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Country | US
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Telephone | 773-318-8959
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. BRYAN BUGAY
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Credential | LCPC
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Telephone | 773-318-8959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149009065
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180005135
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License Number State | IL
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