MEDICARE: MS. ZETAH YOUNG LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180009911	IL

General Provider Information

NPI Number	:	1295105880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ZETAH YOUNG LCPC

Provider Business Mailing Address
First Line	:	4730 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5022
Country	:	US
Telephone Number	:	773-506-7474
Fax Number	:	773-506-9420

Provider Business Practice Location Address
First Line	:	4730 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5022
Country	:	US
Telephone Number	:	773-506-7474
Fax Number	:	773-506-9420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2015
Last Update Date	:	09/25/2015

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